Provider Demographics
NPI:1316943954
Name:LOLLER, STEPHANIE B (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:B
Last Name:LOLLER
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 1:891 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2627
Mailing Address - Country:US
Mailing Address - Phone:408-298-0777
Mailing Address - Fax:408-298-3143
Practice Address - Street 1:891 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2627
Practice Address - Country:US
Practice Address - Phone:408-298-0777
Practice Address - Fax:408-298-3143
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice