Provider Demographics
NPI:1184847949
Name:SHNAYDER, MICHAEL IGOR (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:IGOR
Last Name:SHNAYDER
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17404 BURKE ST
Mailing Address - Street 2:102
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2166
Mailing Address - Country:US
Mailing Address - Phone:402-317-5657
Mailing Address - Fax:
Practice Address - Street 1:17404 BURKE ST
Practice Address - Street 2:102
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2239
Practice Address - Country:US
Practice Address - Phone:402-317-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513751223S0112X
NE67281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery