Provider Demographics
NPI:1992793020
Name:STRADER, RONALD (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:STRADER
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 1:924 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-3910
Mailing Address - Country:US
Mailing Address - Phone:620-231-6788
Mailing Address - Fax:620-231-2331
Practice Address - Street 1:924 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-3910
Practice Address - Country:US
Practice Address - Phone:620-231-6788
Practice Address - Fax:620-231-2331
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1005020Medicaid