Provider Demographics
NPI:1669436598
Name:STOREY, ATHENA CHRISTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:CHRISTINE
Last Name:STOREY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ATHENA
Other - Middle Name:CHRISTINE
Other - Last Name:CONSTANTAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5639 E 5TH ST
Mailing Address - Street 2:SUITE E AND F
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2443
Mailing Address - Country:US
Mailing Address - Phone:520-745-0030
Mailing Address - Fax:520-747-2054
Practice Address - Street 1:5639 E 5TH ST
Practice Address - Street 2:SUITE E AND F
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2443
Practice Address - Country:US
Practice Address - Phone:520-745-0030
Practice Address - Fax:520-747-2054
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice