Provider Demographics
NPI:1811084825
Name:STOLLER, SCOTT COLEMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:COLEMAN
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 1:6554 LIBERTY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8452
Mailing Address - Country:US
Mailing Address - Phone:513-755-2273
Mailing Address - Fax:
Practice Address - Street 1:7237 CINCINNATI DAYTON RD
Practice Address - Street 2:SUITE103
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1773
Practice Address - Country:US
Practice Address - Phone:513-759-9090
Practice Address - Fax:513-759-9095
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 . 0197521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice