| Champagne And Light, Dmds, Llc | |
|
189 Waterman St Providence RI 02906-4014 | |
| (401) 351-0072 | |
| (401) 351-0055 |
| Full Name | Champagne And Light, Dmds, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 189 Waterman St, Providence, Rhode Island |
| Authorized Official Name and Position | Gary Douglas Light (PRINCIPAL) |
| Authorized Official Contact | 4013510072 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Champagne And Light, Dmds, Llc 189 Waterman St Providence RI 02906-4014 Ph: (401) 351-0072 | Champagne And Light, Dmds, Llc 189 Waterman St Providence RI 02906-4014 Ph: (401) 351-0072 |
| NPI Number | 1548439417 |
|---|---|
| Provider Enumeration Date | 02/26/2008 |
| Last Update Date | 02/26/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548439417 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DEN2216 (Rhode Island) | Primary |
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