Provider Demographics
NPI:1891706545
Name:SNELSON, LEE EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:EDWARD
Last Name:SNELSON
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 1:3919 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4718
Mailing Address - Country:US
Mailing Address - Phone:330-856-1433
Mailing Address - Fax:330-856-3911
Practice Address - Street 1:3919 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4718
Practice Address - Country:US
Practice Address - Phone:330-856-1433
Practice Address - Fax:330-856-3911
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-96601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice