Individual
DR. MONICA LEANN CLISSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
807 PARK AVE NE, NORTON, VA 24273
(276) 679-6030
(276) 679-6030
Mailing address
PO BOX 920, CLISSO DENTISTRY, PC, NORTON, VA 24273
(276) 679-6030
(276) 679-6030
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410603
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197242
BLUE CROSS ANTHEM
VA
05
—
9178672
—
VA
Enumeration date
09/10/2008
Last updated
09/10/2008
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