Provider Demographics
NPI:1487812608
Name:CAROLLO, STELLA M (DDS)
Entity type:Individual
Prefix:DR
First Name:STELLA
Middle Name:M
Last Name:CAROLLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:58-47 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364
Mailing Address - Country:US
Mailing Address - Phone:718-224-4000
Mailing Address - Fax:718-224-1921
Practice Address - Street 1:58-47 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364
Practice Address - Country:US
Practice Address - Phone:718-224-4000
Practice Address - Fax:718-224-1921
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0472741223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics