Active NPI
Allen R Stoller, DDS
- General Practice Dentistry
- Berne, IN
National Provider Identifier
1124215504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12007524
- Practice address
- 525 W Parr Rd
Berne, IN 46711-1131 - Phone
- (260) 589-2110
- Fax
- (260) 589-8512
- NPI assigned
- Sep 28, 2007
- Last updated
- Sep 28, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12007524 | IN | Primary |
Addresses
Primary practice location
525 W Parr Rd
Berne, IN 46711-1131
Mailing address
525 W Parr Rd
Berne, IN 46711-1131
Phone (260) 589-2110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12007524 | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Decatur Dental Services, Inc. | Past | Accepting new patients | |
| Stoller Dental Clinic PC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190937600000",
"number": "1124215504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 W PARR RD",
"city": "BERNE",
"state": "IN",
"postal_code": "467111131",
"telephone_number": "260-589-2110",
"fax_number": "260-589-8512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 W PARR RD",
"city": "BERNE",
"state": "IN",
"postal_code": "467111131",
"telephone_number": "260-589-2110",
"fax_number": "260-589-8512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOLLER",
"first_name": "ALLEN",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-28",
"last_updated": "2007-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12007524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.