Provider Demographics
NPI:1467593244
Name:STRASSER, MYRON ROLAND JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:ROLAND
Last Name:STRASSER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1429 COLLEGE AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4057
Mailing Address - Country:US
Mailing Address - Phone:209-529-8872
Mailing Address - Fax:209-571-0808
Practice Address - Street 1:1429 COLLEGE AVE
Practice Address - Street 2:SUITE J
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4057
Practice Address - Country:US
Practice Address - Phone:209-529-8872
Practice Address - Fax:209-571-0808
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADS0386040Medicaid
CAU60211Medicare UPIN