Provider Demographics
NPI:1588797245
Name:SNODGRASS, ALAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:C
Last Name:SNODGRASS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 NE THURSTON WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6655
Mailing Address - Country:US
Mailing Address - Phone:360-514-9212
Mailing Address - Fax:360-514-9214
Practice Address - Street 1:4305 NE THURSTON WAY
Practice Address - Street 2:SUITE A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6655
Practice Address - Country:US
Practice Address - Phone:360-514-9212
Practice Address - Fax:360-514-9214
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000061761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5015417Medicaid
WA01855000Medicare UPIN
WA5015417Medicaid