Provider Demographics
NPI:1386776086
Name:LIGHT, RICK ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:ALAN
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 1:6596 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5615
Mailing Address - Country:US
Mailing Address - Phone:520-297-9069
Mailing Address - Fax:520-575-9600
Practice Address - Street 1:6596 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5615
Practice Address - Country:US
Practice Address - Phone:520-297-9069
Practice Address - Fax:520-575-9600
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist