Provider Demographics
NPI:1821140641
Name:SNYDER, SUSAN ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELAINE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 PARK EAST BVLD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-0788
Mailing Address - Country:US
Mailing Address - Phone:765-447-7878
Mailing Address - Fax:765-449-0665
Practice Address - Street 1:750 PARK EAST BVLD
Practice Address - Street 2:SUITE 5
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0788
Practice Address - Country:US
Practice Address - Phone:765-447-7878
Practice Address - Fax:765-449-0665
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice