Provider Demographics
NPI:1083797104
Name:SNYDER, RANDALL JOHN (DDS, CAGS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JOHN
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DDS, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 N LITCHFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4300
Mailing Address - Country:US
Mailing Address - Phone:623-547-2022
Mailing Address - Fax:623-547-2522
Practice Address - Street 1:4830 N LITCHFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4300
Practice Address - Country:US
Practice Address - Phone:623-547-2022
Practice Address - Fax:623-547-2522
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD65881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics