Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 9152 | MD |
N | 1223X0400X | Orthodontists | 9152 | MD |
NPI | 1063507010 |
---|---|
Provider Name | Dr. Amy Treese Light |
First Address | Potomac, MD 20854-3976 |
Second Address | Potomac, MD 20854-3976 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |