Provider Demographics
NPI:1437697968
Name:STEPHANIE B LOLLER DDS PC
Entity Type:Organization
Organization Name:STEPHANIE B LOLLER DDS PC
Other - Org Name:INSPIRA ADVANCED DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOLLER
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-298-0777
Mailing Address - Street 1:891 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2627
Mailing Address - Country:US
Mailing Address - Phone:408-298-0777
Mailing Address - Fax:408-298-3143
Practice Address - Street 1:891 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2627
Practice Address - Country:US
Practice Address - Phone:408-298-0777
Practice Address - Fax:408-298-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty