MEDICARE: DR. WILLIAM CHRISTIAN STOROE IV D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN 13628	FL

General Provider Information

NPI Number	:	1013912377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM CHRISTIAN STOROE IV D.D.S.

Provider Business Mailing Address
First Line	:	1206 NW 150TH DR
Second Line	:
City	:	NEWBERRY
State	:	FL
Zip	:	32669-2961
Country	:	US
Telephone Number	:	352-332-9709
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 SW 2ND AVE
Second Line	:	STE 2
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-2864
Country	:	US
Telephone Number	:	352-371-4111
Fax Number	:	352-371-1139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. WILLIAM CHRISTIAN STOROE IV D.D.S.” Practice Location

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