Provider Demographics
NPI:1295844090
Name:SNYDER, BRUCE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 N SAN MATEO DR STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2761
Mailing Address - Country:US
Mailing Address - Phone:650-342-9294
Mailing Address - Fax:650-342-1677
Practice Address - Street 1:130 N SAN MATEO DR STE 2
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2761
Practice Address - Country:US
Practice Address - Phone:650-342-9294
Practice Address - Fax:650-342-1677
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics