Provider Demographics
NPI:1083703672
Name:SNIDER, RAY D (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:D
Last Name:SNIDER
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8509 WOODLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3143
Mailing Address - Country:US
Mailing Address - Phone:817-236-1949
Mailing Address - Fax:
Practice Address - Street 1:8461 BOAT CLUB RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-3607
Practice Address - Country:US
Practice Address - Phone:817-236-8771
Practice Address - Fax:817-236-8791
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD12073OtherBC/BS PROVIDER #
TX841904OtherUNITED CONCORDIAPROVIDER#