Provider Demographics
NPI:1508372749
Name:GILBERT H. SNOW DDS INC
Entity Type:Organization
Organization Name:GILBERT H. SNOW DDS INC
Other - Org Name:SANTA CLARITA CHILDREN'S DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:GLENDA
Authorized Official - Last Name:GORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:661-945-0701
Mailing Address - Street 1:1629 W AVENUE J STE 104
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2850
Mailing Address - Country:US
Mailing Address - Phone:661-945-0701
Mailing Address - Fax:661-206-8739
Practice Address - Street 1:27421 TOURNEY RD STE 180
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5646
Practice Address - Country:US
Practice Address - Phone:661-735-1500
Practice Address - Fax:661-799-7231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GILBERT H. SNOW DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-26
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1000261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty