Provider Demographics
NPI:1447387246
Name:LIGHT, DICK (DDS)
Entity type:Individual
Prefix:DR
First Name:DICK
Middle Name:
Last Name:LIGHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W LAUREL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3460
Mailing Address - Country:US
Mailing Address - Phone:831-443-1196
Mailing Address - Fax:831-443-1197
Practice Address - Street 1:275 W LAUREL DR
Practice Address - Street 2:SUITE C
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3460
Practice Address - Country:US
Practice Address - Phone:831-443-1196
Practice Address - Fax:831-443-1197
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice