Provider Demographics
NPI:1184191975
Name:STORIE, JOHN QUINCY (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:QUINCY
Last Name:STORIE
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 1:997 JOHNNIE DODDS BLVD APT 717
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6118
Mailing Address - Country:US
Mailing Address - Phone:423-773-7507
Mailing Address - Fax:
Practice Address - Street 1:997 JOHNNIE DODDS BLVD APT 717
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6118
Practice Address - Country:US
Practice Address - Phone:423-773-7507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC92851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice