Provider Demographics
NPI:1871866558
Name:SNOW, STEPHEN RANDALL (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RANDALL
Last Name:SNOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SAN RAMON VALLEY BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4038
Mailing Address - Country:US
Mailing Address - Phone:925-820-6003
Mailing Address - Fax:
Practice Address - Street 1:909 SAN RAMON VALLEY BLVD STE 216
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4038
Practice Address - Country:US
Practice Address - Phone:925-820-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-11
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice