Individual
JEFFREY G STOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2525 13TH ST, BOULDER, CO 80304-4104
(303) 449-6050
(720) 565-4128
Mailing address
1735 S PUBLIC RD STE 203, LAFAYETTE, CO 80026-7093
(303) 665-3036
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DEN.00008865
CO
363A00000X
Physician Assistant
Primary
PA.0004872
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70609373
—
CO
Enumeration date
02/07/2006
Last updated
05/18/2021
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