Individual
DR. LARISSA ANN DELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
6 NILES HILL RD, COUDERSPORT, PA 16915-1211
(814) 274-1111
Mailing address
6 NILES HILL RD, COUDERSPORT, PA 16915-1211
(814) 274-1111
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS-028583-L
PA
1223G0001X
General Practice Dentistry
DS-028583-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015085930002
MEDICAL ASSISTANCE
PA
Enumeration date
12/20/2006
Last updated
06/27/2024
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