Provider Demographics
NPI:1932299120
Name:MASTRO, LARISSA (DDS)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:MASTRO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ROCK BARN RD NE
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-1709
Mailing Address - Country:US
Mailing Address - Phone:828-464-6742
Mailing Address - Fax:
Practice Address - Street 1:211 ROCK BARN RD NE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-1709
Practice Address - Country:US
Practice Address - Phone:828-464-6742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist