Provider Demographics
NPI:1699397471
Name:SNOW PALMDALE FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:SNOW PALMDALE FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LEONOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-450-0116
Mailing Address - Street 1:4654 E AVENUE S STE A
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-4454
Mailing Address - Country:US
Mailing Address - Phone:661-450-0116
Mailing Address - Fax:661-285-2282
Practice Address - Street 1:4654 E AVENUE S STE A
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4454
Practice Address - Country:US
Practice Address - Phone:661-450-0116
Practice Address - Fax:661-285-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental