Provider Demographics
NPI:1083743363
Name:SNYDER, MARK B (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WALNUT ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2944
Mailing Address - Country:US
Mailing Address - Phone:215-564-4200
Mailing Address - Fax:215-564-0569
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:SUITE 604
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:215-564-4200
Practice Address - Fax:215-564-0569
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018221A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics