Provider Demographics
NPI:1336309798
Name:SNYDER, DUSTIN R (DMD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:R
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FARLEY CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9244
Mailing Address - Country:US
Mailing Address - Phone:570-522-1234
Mailing Address - Fax:570-522-1234
Practice Address - Street 1:111 FARLEY CIR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9244
Practice Address - Country:US
Practice Address - Phone:570-522-1234
Practice Address - Fax:570-522-1234
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist