Provider Demographics
NPI:1336397496
Name:AMY LIGHT, DMD, PC
Entity Type:Organization
Organization Name:AMY LIGHT, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:TREESE
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-983-9804
Mailing Address - Street 1:9812 FALLS RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3976
Mailing Address - Country:US
Mailing Address - Phone:301-983-9804
Mailing Address - Fax:301-983-5571
Practice Address - Street 1:9812 FALLS RD
Practice Address - Street 2:SUITE 118
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3976
Practice Address - Country:US
Practice Address - Phone:301-983-9804
Practice Address - Fax:301-983-5571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD91521223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty