Provider Demographics
NPI:1174662241
Name:STOLL, LLOYD ERCELL (DDS)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:ERCELL
Last Name:STOLL
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 1:1828 E CESAR E CHAVEZ AVE STE B10
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2400
Mailing Address - Country:US
Mailing Address - Phone:323-268-1805
Mailing Address - Fax:323-268-2412
Practice Address - Street 1:1828 E CESAR E CHAVEZ AVE STE B10
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2400
Practice Address - Country:US
Practice Address - Phone:323-268-1805
Practice Address - Fax:323-268-2412
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16647122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist