| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 807 Park Ave Ne, Norton, Virginia |
| Authorized Official Name and Position | Monica Leann Clisso (OWNER OPERATOR DENTIST) |
| Authorized Official Contact | 2766796030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 920 Norton VA 24273 Ph: (276) 679-6030 | 807 Park Ave Ne Norton VA 24273 Ph: (276) 679-6030 |
| NPI Number | 1336275973 |
|---|---|
| Provider Enumeration Date | 02/26/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336275973 | NPI | - | NPPES |
| 197242 | Other | ANTHEM BCBS OF VA | |
| 9178672 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 0401410603 (Virginia) | Primary |
Dr Olivia Stallards Downtown Dental Pllc Dental Clinic Medicare: Medicare Enrolled Practice Location: 616 Market Pl Sw, Norton, VA 24273 Phone: 276-325-0194 |