Provider Demographics
NPI:1447450440
Name:STRAYER, DESIREE E (DDS)
Entity type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:E
Last Name:STRAYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 ALPINE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CONSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-8909
Mailing Address - Country:US
Mailing Address - Phone:616-784-4777
Mailing Address - Fax:616-784-0774
Practice Address - Street 1:4040 ALPINE AVE NW
Practice Address - Street 2:
Practice Address - City:CONSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-8909
Practice Address - Country:US
Practice Address - Phone:616-784-4777
Practice Address - Fax:616-784-0774
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI15540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist