Provider Demographics
NPI:1689028128
Name:STORB DENTAL, LLC
Entity Type:Organization
Organization Name:STORB DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:STORB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:717-445-4422
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:TERRE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17581-0730
Mailing Address - Country:US
Mailing Address - Phone:717-445-4422
Mailing Address - Fax:717-445-4979
Practice Address - Street 1:422 MAPLE ST.
Practice Address - Street 2:
Practice Address - City:TERRE HILL
Practice Address - State:PA
Practice Address - Zip Code:17581
Practice Address - Country:US
Practice Address - Phone:717-445-4422
Practice Address - Fax:717-445-4979
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TERRE DENTAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-18459-L1223E0200X
PADS-026723-L1223G0001X
PADS-0383451223G0001X
PADS-027636-L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty