Provider Demographics
NPI:1285729905
Name:STOLZ, GINA LAVELLA (DDS)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:LAVELLA
Last Name:STOLZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8244 S GARY AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-1334
Mailing Address - Country:US
Mailing Address - Phone:918-492-4511
Mailing Address - Fax:918-749-0416
Practice Address - Street 1:3150 E 41ST ST
Practice Address - Street 2:SUITE 131
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3717
Practice Address - Country:US
Practice Address - Phone:918-749-1639
Practice Address - Fax:918-749-0416
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice