Provider Demographics
NPI:1578570206
Name:STORM, ELLIOT R (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:R
Last Name:STORM
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-4401
Mailing Address - Country:US
Mailing Address - Phone:914-946-3350
Mailing Address - Fax:914-761-4468
Practice Address - Street 1:765 NORTH ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-4401
Practice Address - Country:US
Practice Address - Phone:914-946-3350
Practice Address - Fax:914-761-4468
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY368691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics