Healthcare Provider Details

I. General information

NPI: 1396550067
Provider Name (Legal Business Name): LARISSA YAMASAKI LOPES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 FEDERAL RD STE C15
BROOKFIELD CT
06804-2651
US

IV. Provider business mailing address

246 FEDERAL RD STE C15
BROOKFIELD CT
06804-2651
US

V. Phone/Fax

Practice location:
  • Phone: 203-512-1060
  • Fax:
Mailing address:
  • Phone: 203-512-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14614
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14614
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: