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General NPI Number Information
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NPI Number | 1336397496
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Entity Type | Organization
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Legal Business Name | AMY LIGHT, DMD, PC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 9812 FALLS RD SUITE 118
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City | POTOMAC
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State | MD
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Zip | 20854-3976
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Country | US
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Telephone | 301-983-9804
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Fax | 301-983-5571
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Provider Business Mailing Address
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Address Line | 9812 FALLS RD SUITE 118
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City | POTOMAC
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State | MD
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Zip | 20854-3976
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Country | US
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Telephone | 301-983-9804
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Fax | 301-983-5571
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMY TREESE LIGHT
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Credential | DMD
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Telephone | 301-983-9804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 9152
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9152
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License Number State | MD
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