Provider Demographics
NPI:1124330592
Name:STORM, JULIE JO (DMD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:JO
Last Name:STORM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:JO
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7901 NE 10TH ST
Mailing Address - Street 2:B103
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3600
Mailing Address - Country:US
Mailing Address - Phone:405-737-0404
Mailing Address - Fax:405-737-0934
Practice Address - Street 1:7901 NE 10TH ST
Practice Address - Street 2:B103
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3600
Practice Address - Country:US
Practice Address - Phone:405-737-0404
Practice Address - Fax:405-737-0934
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD80131223G0001X
OK6242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice