Provider Demographics
NPI:1972208684
Name:FUTCH, STORMIE EVE
Entity Type:Individual
Prefix:
First Name:STORMIE
Middle Name:EVE
Last Name:FUTCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 WHITE IBIS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2641
Mailing Address - Country:US
Mailing Address - Phone:941-257-8555
Mailing Address - Fax:
Practice Address - Street 1:4901 WHITE IBIS DR
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2641
Practice Address - Country:US
Practice Address - Phone:941-257-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist