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General NPI Number Information
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NPI Number | 1841492238
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Entity Type | Organization
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Legal Business Name | STOLLER DENTAL CLINIC PC
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 525 W PARR RD
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City | BERNE
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State | IN
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Zip | 46711-1131
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Country | US
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Telephone | 260-589-2110
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Fax | 260-589-8512
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Provider Business Mailing Address
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Address Line | 525 W PARR RD
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City | BERNE
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State | IN
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Zip | 46711-1131
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Country | US
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Telephone | 260-589-2110
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Fax | 260-589-8512
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALLEN R STOLLER
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Credential | DDS
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Telephone | 260-589-2110
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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 | 12007524A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 54001449A
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License Number State | IN
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