Provider Demographics
NPI:1346293206
Name:SNIDER, LARRY L (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:L
Last Name:SNIDER
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1578
Mailing Address - Country:US
Mailing Address - Phone:303-232-5637
Mailing Address - Fax:303-232-5638
Practice Address - Street 1:2290 KIPLING ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1578
Practice Address - Country:US
Practice Address - Phone:303-232-5637
Practice Address - Fax:303-232-5638
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC82245Medicare PIN