Provider Demographics
NPI:1881648012
Name:SNEIDER, RANDALL MYLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:MYLES
Last Name:SNEIDER
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 1:18 SEVLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2840
Mailing Address - Country:US
Mailing Address - Phone:617-964-0922
Mailing Address - Fax:617-964-1867
Practice Address - Street 1:313 WASHINGTON ST
Practice Address - Street 2:SUITE 217
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1626
Practice Address - Country:US
Practice Address - Phone:617-332-9628
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11032OtherDENTAL LICENSE