Provider Demographics
NPI:1518027101
Name:SNIDER PAWELEK, JACQUELINE MARIE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:SNIDER PAWELEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:MARIE
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:84 CHADWICK MANOR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450
Mailing Address - Country:US
Mailing Address - Phone:585-425-8708
Mailing Address - Fax:
Practice Address - Street 1:2061 RIDGE RD WEST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-225-9000
Practice Address - Fax:585-225-6312
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04588611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry