Individual
TIMOTHY J STORM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1000 E MOUNTAIN BLVD, WILKES BARRE, PA 18711-0027
(570) 819-5626
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS039565
PA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS039565
PA
Other
Enumeration date
07/23/2013
Last updated
08/20/2020
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