Provider Demographics
NPI:1528187960
Name:SNYDER, W. RANDY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:W. RANDY
Middle Name:
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6977
Mailing Address - Country:US
Mailing Address - Phone:325-947-3636
Mailing Address - Fax:325-942-7594
Practice Address - Street 1:3131 GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6977
Practice Address - Country:US
Practice Address - Phone:325-947-3636
Practice Address - Fax:325-942-7594
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171651223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics