Provider Demographics
NPI:1023280641
Name:WILLIAM C STOROE IV DDS PA
Entity type:Organization
Organization Name:WILLIAM C STOROE IV DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:STOROE
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-371-4111
Mailing Address - Street 1:3500 SW 2ND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2820
Mailing Address - Country:US
Mailing Address - Phone:352-371-4111
Mailing Address - Fax:352-371-1139
Practice Address - Street 1:3500 SW 2ND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2820
Practice Address - Country:US
Practice Address - Phone:352-371-4111
Practice Address - Fax:352-371-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery