Provider Demographics
NPI:1730238650
Name:STOLARZ, JEFFREY ALAN (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:STOLARZ
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 1:1032 119TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1514
Mailing Address - Country:US
Mailing Address - Phone:219-659-7060
Mailing Address - Fax:219-659-2118
Practice Address - Street 1:1032 119TH ST
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1514
Practice Address - Country:US
Practice Address - Phone:219-659-7060
Practice Address - Fax:219-659-2118
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010194A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice