Provider Demographics
NPI:1841400678
Name:STORACE, ANTHONY M (DMD, MAGD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:STORACE
Suffix:
Gender:M
Credentials:DMD, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MERRIT PARKWAY
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3029
Mailing Address - Country:US
Mailing Address - Phone:603-880-3496
Mailing Address - Fax:603-886-9493
Practice Address - Street 1:20 MERRIT PARKWAY
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3029
Practice Address - Country:US
Practice Address - Phone:603-880-3496
Practice Address - Fax:603-886-9493
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice