Provider Demographics
NPI:1407069792
Name:ROSS W STRYKER DDS PC
Entity Type:Organization
Organization Name:ROSS W STRYKER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:W
Authorized Official - Last Name:STRYKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:417-532-9532
Mailing Address - Street 1:PO BOX 1193
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-1193
Mailing Address - Country:US
Mailing Address - Phone:417-532-9532
Mailing Address - Fax:417-532-9526
Practice Address - Street 1:590 LYNN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-2409
Practice Address - Country:US
Practice Address - Phone:417-532-9532
Practice Address - Fax:417-532-9526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO138091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty