Provider Demographics
NPI:1386009785
Name:SUSAN E SNYDER DDS, PC
Entity Type:Organization
Organization Name:SUSAN E SNYDER DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-447-7878
Mailing Address - Street 1:750 PARK EAST BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-0788
Mailing Address - Country:US
Mailing Address - Phone:765-447-7878
Mailing Address - Fax:765-449-0665
Practice Address - Street 1:750 PARK EAST BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0788
Practice Address - Country:US
Practice Address - Phone:765-447-7878
Practice Address - Fax:765-449-0665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty