Provider Demographics
NPI:1649763475
Name:SNYDER, MADALYN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:MADALYN
Middle Name:E
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1893 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-6251
Mailing Address - Country:US
Mailing Address - Phone:815-936-6461
Mailing Address - Fax:
Practice Address - Street 1:482 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2324
Practice Address - Country:US
Practice Address - Phone:815-939-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0316161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice