=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407069792
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSS W STRYKER DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 09/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 LYNN ST
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65536-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-532-9532
-----------------------------------------------------
Fax | 417-532-9526
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1193
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65536-1193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-532-9532
-----------------------------------------------------
Fax | 417-532-9526
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST
-----------------------------------------------------
Name | DR. ROSS W STRYKER
-----------------------------------------------------
Credential | D.D.S., P.C.
-----------------------------------------------------
Telephone | 417-532-9532
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 13809
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------