Provider Demographics
NPI:1497881544
Name:STOREY, JOHN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:STOREY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:MICHAEL
Other - Last Name:STOREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:424 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2572
Mailing Address - Country:US
Mailing Address - Phone:814-724-7268
Mailing Address - Fax:
Practice Address - Street 1:424 NORTH ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2572
Practice Address - Country:US
Practice Address - Phone:814-724-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN024667A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice