Provider Demographics
NPI:1790745594
Name:SNYDER, RANDOLPH A (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:A
Last Name:SNYDER
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 1:1325 W 16TH ST
Mailing Address - Street 2:1
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4496
Mailing Address - Country:US
Mailing Address - Phone:928-343-0098
Mailing Address - Fax:
Practice Address - Street 1:1325 W 16TH ST
Practice Address - Street 2:1
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4496
Practice Address - Country:US
Practice Address - Phone:928-343-0098
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics