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General NPI Number Information
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NPI Number | 1437697968
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Entity Type | Organization
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Legal Business Name | STEPHANIE B LOLLER DDS PC
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 891 S BASCOM AVE
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City | SAN JOSE
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State | CA
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Zip | 95128-2627
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Country | US
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Telephone | 408-298-0777
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Fax | 408-298-3143
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Provider Business Mailing Address
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Address Line | 891 S BASCOM AVE
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City | SAN JOSE
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State | CA
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Zip | 95128-2627
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Country | US
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Telephone | 408-298-0777
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Fax | 408-298-3143
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHANIE B LOLLER I
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Credential | DDS
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Telephone | 408-298-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 44610
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License Number State | CA
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