Provider Demographics
NPI:1891471470
Name:STORB, MITCHEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:
Last Name:STORB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2141
Mailing Address - Country:US
Mailing Address - Phone:717-823-1495
Mailing Address - Fax:
Practice Address - Street 1:422 MAPLE ST
Practice Address - Street 2:
Practice Address - City:TERRE HILL
Practice Address - State:PA
Practice Address - Zip Code:17581-9613
Practice Address - Country:US
Practice Address - Phone:717-445-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0440711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice