Provider Demographics
NPI:1073702767
Name:SNIDER-GOMEZ, ERICA MICHELLE (DDS)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MICHELLE
Last Name:SNIDER-GOMEZ
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 1:1416 BETA CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE CLARKE SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7810
Mailing Address - Country:US
Mailing Address - Phone:586-567-2127
Mailing Address - Fax:
Practice Address - Street 1:427 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3511
Practice Address - Country:US
Practice Address - Phone:561-996-0960
Practice Address - Fax:561-996-0960
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN178371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice