Provider Demographics
NPI:1942395363
Name:STRAYER, MICHAEL S (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:STRAYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 COPELAND MILL RD.
Mailing Address - Street 2:SUITE 2H
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081
Mailing Address - Country:US
Mailing Address - Phone:614-890-3130
Mailing Address - Fax:
Practice Address - Street 1:17273 ST RT 104
Practice Address - Street 2:VAMC-DENTAL (160)
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:740-772-7104
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-52191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice