MEDICARE: ROMEO I. STOLL, DDS, MS INC

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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	19466	CA

General Provider Information

NPI Number	:	1003932112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROMEO I. STOLL, DDS, MS INC

Provider Business Mailing Address
First Line	:	1340 W AVENUE J
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-2936
Country	:	US
Telephone Number	:	661-948-4674
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 W AVENUE J
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-2936
Country	:	US
Telephone Number	:	661-948-4674
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ROMEO I STOLL
Credential	:	DDS, MS
Telephone Number	:	661-948-4674

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	12/15/2009

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