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NPI Code Detail

MEDICARE: MARCELLE DESRONVIL-LISSADE DMD

MEDICARE: MARCELLE DESRONVIL-LISSADE DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist8716NC

General Provider Information

NPI Number : 1538206537
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCELLE DESRONVIL-LISSADE DMD
Provider Business Mailing Address
First Line : 2127 CRIGAN BLUFF DR
Second Line :
City : CARY
State : NC
Zip : 27513-8352
Country : US
Telephone Number : 267-981-0360
Fax Number :
Provider Business Practice Location Address
First Line : 1111 S POLLOCK ST
Second Line :
City : SELMA
State : NC
Zip : 27576-2933
Country : US
Telephone Number : 919-965-2552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 05/22/2024

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Directions to “ MARCELLE DESRONVIL-LISSADE DMD” Practice Location

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