Individual
DR. MARY ELIZABETH DI LISIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
618 SAINT LOUIS ST, EDWARDSVILLE, IL 62025-1504
(618) 656-7111
Mailing address
618 SAINT LOUIS ST, EDWARDSVILLE, IL 62025-1504
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019032708
IL
Other
Enumeration date
07/02/2020
Last updated
07/02/2020
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