Provider Demographics
NPI:1821369018
Name:SNYDER FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:SNYDER FAMILY DENTISTRY PLLC
Other - Org Name:SNYDER FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-878-1675
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-0254
Mailing Address - Country:US
Mailing Address - Phone:616-878-1675
Mailing Address - Fax:616-878-3455
Practice Address - Street 1:2700 84TH ST SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9230
Practice Address - Country:US
Practice Address - Phone:616-878-1675
Practice Address - Fax:616-878-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020012261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental