Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 013809 | MO |
NPI | 1053337410 |
---|---|
Provider Name | Dr. Ross W Stryker |
First Address | Lebanon, MO 65536-1193 |
Second Address | Lebanon, MO 65536-2409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 08/07/2007 |