Provider Demographics
NPI:1811412562
Name:SNOW & SNOW DDS PLLC
Entity Type:Organization
Organization Name:SNOW & SNOW DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-875-9158
Mailing Address - Street 1:5306 SOUTH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4116
Mailing Address - Country:US
Mailing Address - Phone:980-226-5400
Mailing Address - Fax:980-226-5927
Practice Address - Street 1:5306 SOUTH BLVD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-4116
Practice Address - Country:US
Practice Address - Phone:980-875-9158
Practice Address - Fax:980-875-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9178122300000X
NC9054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003996919Medicaid
NC1568575330Medicaid