| NPI | 1851688816 |
|---|---|
| Doing Business As | LIGHT STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | NICOLE CELESTE FOREL Manager 410-659-0901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 13598) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2011-06-28 |