# CLISSO DENTISTRY PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clisso Dentistry PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336275973
- **Authorized official:** MONICA LEANN CLISSO DDS (OWNER OPERATOR DENTIST)
- **Authorized official phone:** (276) 679-6030

## Contact information

- **Practice address:** 807 PARK AVE NE, NORTON, VA 24273
- **Practice address phone:** (276) 679-6030
- **Practice address fax:** (276) 679-6030
- **Mailing address:** PO BOX 920, NORTON, VA 24273
- **Mailing address phone:** (276) 679-6030
- **Mailing address fax:** (276) 679-6030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401410603 | VA | Yes |

## Other

- **Enumeration date:** 02/26/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 197242 | ANTHEM BCBS OF VA | — |
| 05 | — | 9178672 | — | VA |