Provider Demographics
NPI:1598882763
Name:STOREN, THOMAS MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:STOREN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 QUEENS WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3050
Mailing Address - Country:US
Mailing Address - Phone:248-644-8484
Mailing Address - Fax:
Practice Address - Street 1:4395 QUEENS WAY
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3050
Practice Address - Country:US
Practice Address - Phone:248-644-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2009-09-01
Deactivation Date:2008-01-30
Deactivation Code:
Reactivation Date:2009-09-01
Provider Licenses
StateLicense IDTaxonomies
MI0095151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice