Stoller, Chad

Stoller, Chad is an individual health care provider with primary practice located at 2828 E State Blvd , Fort Wayne IN 46805-4761. He recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Dental Providers / Dentist. Dental Providers / Dentist is his primary health care specialty. Stoller, Chad can be contacted via phone (260) 482-6689.

Contact Information

Primary practice address
2828 E State Blvd Fort Wayne IN 46805-4761
Phone: (260) 482-6689
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 5601003571 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 5601003571 Michigan
Dental Providers / Dentist 122300000X 12013438A Indiana

Profile Details

NPI number 1700871118
LBN Legal business name Stoller, Chad
Credentials DDS, PA-C
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 13th, 2005
Last updated Jul 22nd, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700871118 NPPES
Other 970021317 RAILROAD MEDICARE

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