Provider Demographics
NPI:1538188016
Name:LIGHT, JEFFREY G (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:G
Last Name:LIGHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8822 BARRISTER LN
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6350
Mailing Address - Country:US
Mailing Address - Phone:916-715-1485
Mailing Address - Fax:916-456-9157
Practice Address - Street 1:2650 21ST ST STE 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2539
Practice Address - Country:US
Practice Address - Phone:916-451-9400
Practice Address - Fax:916-456-9157
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA303811223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics