Provider Demographics
NPI:1942378856
Name:LIGHT, TODD DEREK (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:DEREK
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 1:10581 RIDGECREST CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-1829
Mailing Address - Country:US
Mailing Address - Phone:303-550-2242
Mailing Address - Fax:
Practice Address - Street 1:201 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4657
Practice Address - Country:US
Practice Address - Phone:303-321-2233
Practice Address - Fax:303-321-0967
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice