Provider Demographics
NPI:1306991237
Name:STORER, K H (DDS, MAGD)
Entity type:Individual
Prefix:DR
First Name:K
Middle Name:H
Last Name:STORER
Suffix:
Gender:M
Credentials:DDS, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N 182ND ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4430
Mailing Address - Country:US
Mailing Address - Phone:206-546-4109
Mailing Address - Fax:206-542-3812
Practice Address - Street 1:701 N 182ND ST
Practice Address - Street 2:SUITE #103
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4430
Practice Address - Country:US
Practice Address - Phone:206-546-4109
Practice Address - Fax:206-542-3812
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA53331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911-882027OtherTAX ID NUMBER