Provider Demographics
NPI:1003037573
Name:LIGHT, STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
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 1:325 N INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-1340
Mailing Address - Country:US
Mailing Address - Phone:618-548-1226
Mailing Address - Fax:
Practice Address - Street 1:500 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1516
Practice Address - Country:US
Practice Address - Phone:618-548-0774
Practice Address - Fax:618-548-1135
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice