Provider Demographics
NPI:1033710025
Name:THERESA M. SNELL
Entity Type:Organization
Organization Name:THERESA M. SNELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-633-6087
Mailing Address - Street 1:580 5TH AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2836
Mailing Address - Country:US
Mailing Address - Phone:651-633-6087
Mailing Address - Fax:
Practice Address - Street 1:580 5TH AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-2836
Practice Address - Country:US
Practice Address - Phone:651-633-6087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental