Provider Demographics
NPI:1912006545
Name:SNODGRASS, PHILIP E (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:E
Last Name:SNODGRASS
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 1:39572 STEVENSON PLACE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3112
Mailing Address - Country:US
Mailing Address - Phone:510-796-7477
Mailing Address - Fax:510-796-0951
Practice Address - Street 1:39572 STEVENSON PLACE
Practice Address - Street 2:SUITE 225
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3112
Practice Address - Country:US
Practice Address - Phone:510-796-7477
Practice Address - Fax:510-796-0951
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist