Provider Demographics
NPI:1134564388
Name:SNEDAKER, DANIEL JED (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JED
Last Name:SNEDAKER
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 1:11535 S JORDAN BEND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8066
Mailing Address - Country:US
Mailing Address - Phone:801-360-8868
Mailing Address - Fax:
Practice Address - Street 1:11535 S JORDAN BEND RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8066
Practice Address - Country:US
Practice Address - Phone:801-360-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8689248-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist