Provider Demographics
NPI:1164526513
Name:SNYDER, KELLY ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANNE
Last Name:SNYDER
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 1:2101 AURELIUS RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1380
Mailing Address - Country:US
Mailing Address - Phone:517-694-4700
Mailing Address - Fax:
Practice Address - Street 1:2101 AURELIUS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1380
Practice Address - Country:US
Practice Address - Phone:517-694-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI186141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice