Provider Demographics
NPI:1295868537
Name:SNYDER, JILL MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041-3037
Mailing Address - Country:US
Mailing Address - Phone:765-654-7222
Mailing Address - Fax:765-654-6401
Practice Address - Street 1:1009 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-3037
Practice Address - Country:US
Practice Address - Phone:765-654-7222
Practice Address - Fax:765-654-6401
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009266A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice