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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