Provider Demographics
NPI:1962774919
Name:STOLL, DENNIS W (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
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 1:822 E. HARRISON STREET
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7120
Mailing Address - Country:US
Mailing Address - Phone:956-428-4398
Mailing Address - Fax:956-428-1868
Practice Address - Street 1:822 E. HARRISON ST.
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7120
Practice Address - Country:US
Practice Address - Phone:956-428-4398
Practice Address - Fax:956-428-1868
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111098303Medicaid