Provider Demographics
NPI:1952638504
Name:SNYDER, FLOYD KENNETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:FLOYD
Middle Name:KENNETH
Last Name:SNYDER
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:PO BOX 13600
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85002-3600
Mailing Address - Country:US
Mailing Address - Phone:602-261-6872
Mailing Address - Fax:602-261-6816
Practice Address - Street 1:420 W WATKINS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2830
Practice Address - Country:US
Practice Address - Phone:602-261-6872
Practice Address - Fax:602-261-6816
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ20561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ183509Medicaid