Provider Demographics
NPI:1124215504
Name:STOLLER, ALLEN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:R
Last Name:STOLLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W PARR RD
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-1131
Mailing Address - Country:US
Mailing Address - Phone:260-589-2110
Mailing Address - Fax:260-589-8512
Practice Address - Street 1:525 W PARR RD
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-1131
Practice Address - Country:US
Practice Address - Phone:260-589-2110
Practice Address - Fax:260-589-8512
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120075241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice