Provider Demographics
NPI:1992848998
Name:LIGHT, ARMENTINA DIAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARMENTINA
Middle Name:DIAO
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 1:15 MAREBLU
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3067
Mailing Address - Country:US
Mailing Address - Phone:949-362-1142
Mailing Address - Fax:949-362-4102
Practice Address - Street 1:15 MAREBLU
Practice Address - Street 2:SUITE 280
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3015
Practice Address - Country:US
Practice Address - Phone:949-362-1142
Practice Address - Fax:949-362-4102
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist