Provider Demographics
NPI:1639334188
Name:STOLIS, ELAINE GLORIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:GLORIA
Last Name:STOLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8114 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2206
Mailing Address - Country:US
Mailing Address - Phone:708-974-9550
Mailing Address - Fax:
Practice Address - Street 1:8114 W 111TH ST
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-2206
Practice Address - Country:US
Practice Address - Phone:708-974-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190181551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice