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Organization
CLISSO DENTISTRY PC
Active
Organization
CLISSO DENTISTRY PC
Active
Other names
Clisso Dentistry PC
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA LEANN CLISSO DDS (OWNER OPERATOR DENTIST)
(276) 679-6030
Entity
Organization
Contact information
Practice address
807 PARK AVE NE, NORTON, VA 24273
(276) 679-6030
(276) 679-6030
Mailing address
PO BOX 920, NORTON, VA 24273
(276) 679-6030
(276) 679-6030
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401410603
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197242
ANTHEM BCBS OF VA
—
05
—
9178672
—
VA
Enumeration date
02/26/2007
Last updated
08/22/2020
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