Provider Demographics
NPI:1699745950
Name:STORZ, JOHN PETER (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:STORZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 VERNON ST NW
Mailing Address - Street 2:APT 106
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1261
Mailing Address - Country:US
Mailing Address - Phone:202-518-4107
Mailing Address - Fax:703-325-2358
Practice Address - Street 1:9515 HALL ROAD
Practice Address - Street 2:BUILDING 1099
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:703-806-4393
Practice Address - Fax:703-806-4376
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185691223G0001X
CODEN-75661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice