Provider Demographics
NPI:1245400902
Name:SNIPES, WILLIAM BRADLEY SR (DMD, MS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRADLEY
Last Name:SNIPES
Suffix:SR
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WAUGH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8918
Mailing Address - Country:US
Mailing Address - Phone:706-217-2890
Mailing Address - Fax:
Practice Address - Street 1:1200 W WAUGH ST
Practice Address - Street 2:SUITE C
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8918
Practice Address - Country:US
Practice Address - Phone:706-217-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-08
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA109351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics