Provider Demographics
NPI:1699813147
Name:SNOW, IRENE ROSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:ROSE
Last Name:SNOW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 S OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3102
Mailing Address - Country:US
Mailing Address - Phone:216-963-3430
Mailing Address - Fax:
Practice Address - Street 1:2185 S OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3102
Practice Address - Country:US
Practice Address - Phone:216-965-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-166791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2303617Medicaid