Provider Demographics
NPI:1255479929
Name:LIGHT, CAROLYN C (DDS)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:C
Last Name:LIGHT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NEWPORT CENTER DR STE 209
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7645
Mailing Address - Country:US
Mailing Address - Phone:949-760-1051
Mailing Address - Fax:949-760-2654
Practice Address - Street 1:400 NEWPORT CENTER DR STE 209
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7645
Practice Address - Country:US
Practice Address - Phone:949-760-1051
Practice Address - Fax:949-760-2654
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice