Provider Demographics
NPI:1396959854
Name:STORB, LEWIS ALLEN (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:ALLEN
Last Name:STORB
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:422 MAPLE STREET
Mailing Address - City:TERRE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17581-0730
Mailing Address - Country:US
Mailing Address - Phone:717-445-4422
Mailing Address - Fax:717-445-4979
Practice Address - Street 1:422 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:TERRE HILL
Practice Address - State:PA
Practice Address - Zip Code:17581-0730
Practice Address - Country:US
Practice Address - Phone:717-445-4422
Practice Address - Fax:717-445-4979
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-026723-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist