Provider Demographics
NPI:1750487815
Name:SNELL, THERESA MARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARY
Last Name:SNELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:MARY
Other - Last Name:MENNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:580 5TH AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:651-633-6087
Mailing Address - Fax:651-633-3593
Practice Address - Street 1:580 5TH AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:651-633-6087
Practice Address - Fax:651-633-3593
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist