Healthcare Provider Details

I. General information

NPI: 1881729259
Provider Name (Legal Business Name): KATHLEEN ELIZABETH LOLLA D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 BROAD ST STE 7
RED BANK NJ
07701-2012
US

IV. Provider business mailing address

691 MICHAEL DR
TOMS RIVER NJ
08753-5684
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-2022
  • Fax:
Mailing address:
  • Phone: 732-930-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI 15126
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: