Provider Demographics
NPI:1780778951
Name:STORTS AND SUDBERRY PLLC
Entity type:Organization
Organization Name:STORTS AND SUDBERRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:STORTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:580-223-6720
Mailing Address - Street 1:615 N COMMERCE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401
Mailing Address - Country:US
Mailing Address - Phone:580-223-6720
Mailing Address - Fax:580-223-6724
Practice Address - Street 1:615 N COMMERCE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-223-6720
Practice Address - Fax:580-223-6724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5443122300000X
OK4633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty