Organization
CHAMPAGNE AND LIGHT, DMDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY DOUGLAS LIGHT D.M.D. (PRINCIPAL)
(401) 351-0072
Entity
Organization
Contact information
Practice address
189 WATERMAN ST, PROVIDENCE, RI 02906-4014
(401) 351-0072
(401) 351-0055
Mailing address
189 WATERMAN ST, PROVIDENCE, RI 02906-4014
(401) 351-0072
(401) 351-0055
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN2216
RI
Other
Enumeration date
02/26/2008
Last updated
02/26/2008
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