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General NPI Number Information
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NPI Number | 1649337494
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Entity Type | Individual
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Provider Name | TERRILL LEE STOLLER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 60420 US 31 S
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City | SOUTH BEND
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State | IN
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Zip | 46614-5138
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Country | US
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Telephone | 574-291-6020
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Fax | 574-291-6051
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Provider Business Mailing Address
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Address Line | 60420 US 31 S
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City | SOUTH BEND
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State | IN
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Zip | 46614-5138
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Country | US
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Telephone | 574-291-6020
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Fax | 574-291-6051
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12007302A
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License Number State | IN
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