Provider Demographics
NPI:1790272904
Name:SNIDER, TAYLOR N (DMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:N
Last Name:SNIDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 FERNCROFT RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-2635
Mailing Address - Country:US
Mailing Address - Phone:978-867-0860
Mailing Address - Fax:
Practice Address - Street 1:1150 N LAKE SHORE DR APT 20G
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5233
Practice Address - Country:US
Practice Address - Phone:256-738-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAPPLYING122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty