Provider Demographics
NPI:1609957794
Name:STOREY, KATIE M (DMD)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:M
Last Name:STOREY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5605
Mailing Address - Country:US
Mailing Address - Phone:509-582-9185
Mailing Address - Fax:509-586-8179
Practice Address - Street 1:660 SWIFT BLVD STE C
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3560
Practice Address - Country:US
Practice Address - Phone:509-946-9025
Practice Address - Fax:509-946-3779
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA79541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice