Provider Demographics
NPI:1013927482
Name:STOLLER, STANLEY MERRILL (DDS)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:MERRILL
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 1:6120 BRANDON AVE
Mailing Address - Street 2:#317
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150
Mailing Address - Country:US
Mailing Address - Phone:703-451-6800
Mailing Address - Fax:703-451-0353
Practice Address - Street 1:6120 BRANDON AVE
Practice Address - Street 2:#317
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150
Practice Address - Country:US
Practice Address - Phone:703-451-6800
Practice Address - Fax:703-451-0353
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010032931223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics