Provider Demographics
NPI:1790915692
Name:SNYDER, MATTHEW RYAN (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
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 1:220 FALCON PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHRIEVER AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80912-5005
Mailing Address - Country:US
Mailing Address - Phone:719-567-4293
Mailing Address - Fax:
Practice Address - Street 1:559 VINCENT ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80914-1541
Practice Address - Country:US
Practice Address - Phone:440-503-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-26
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0230181223G0001X
CO00203779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice