Provider Demographics
NPI:1427438316
Name:STANLEY, LARISSA RACHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:RACHELLE
Last Name:STANLEY
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 1:521 THE GREENS CIR APT 420
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-5290
Mailing Address - Country:US
Mailing Address - Phone:910-977-7665
Mailing Address - Fax:
Practice Address - Street 1:407 TIFFANY DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-9306
Practice Address - Country:US
Practice Address - Phone:919-774-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist