=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063630101
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD WAYNE OCHSNER D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 12/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1502 E BROADWAY SUITE 201
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65201-8076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-441-9441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 VANDIVER DR SUITE V
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65202-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-441-9441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 13503
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------