Provider Demographics
NPI:1023182144
Name:LIGH, RANDY Q (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:Q
Last Name:LIGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:189 N BASCOM AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1869
Mailing Address - Country:US
Mailing Address - Phone:408-286-6308
Mailing Address - Fax:408-286-6319
Practice Address - Street 1:189 N BASCOM AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1869
Practice Address - Country:US
Practice Address - Phone:408-286-6308
Practice Address - Fax:408-286-6319
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA261991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry