Provider Demographics
NPI:1588726046
Name:STOLL, JAMES GARY
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GARY
Last Name:STOLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:8226 N MAIN ST
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057
Mailing Address - Country:US
Mailing Address - Phone:716-992-4047
Mailing Address - Fax:
Practice Address - Street 1:8226 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NY
Practice Address - Zip Code:14057
Practice Address - Country:US
Practice Address - Phone:716-992-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist