Individual
DR. LARISSA MAE TOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1347 S. BEVERLY, CASPER, WY 82609-4133
(307) 577-0577
Mailing address
5230 S ELM ST, CASPER, WY 82601-6315
(303) 345-4187
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1227
WY
Other
Enumeration date
12/09/2008
Last updated
09/25/2013
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