Provider Demographics
NPI:1639238009
Name:SNYDER, LARRY ALLAN (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ALLAN
Last Name:SNYDER
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 1:2070 S PARK PL SE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2045
Mailing Address - Country:US
Mailing Address - Phone:770-955-1188
Mailing Address - Fax:
Practice Address - Street 1:2070 S PARK PL SE
Practice Address - Street 2:SUITE 330
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2045
Practice Address - Country:US
Practice Address - Phone:770-955-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice