Provider Demographics
NPI:1891796280
Name:SNYDER DENTAL GROUP
Entity Type:Organization
Organization Name:SNYDER DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:I MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-839-1470
Mailing Address - Street 1:4575 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4567
Mailing Address - Country:US
Mailing Address - Phone:716-839-1470
Mailing Address - Fax:716-839-3484
Practice Address - Street 1:4575 MAIN ST
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4567
Practice Address - Country:US
Practice Address - Phone:716-839-1470
Practice Address - Fax:716-839-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04568811223E0200X
NY04616911223G0001X
NY0249001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty