Provider Demographics
NPI:1295929677
Name:KELLY ANNE SNYDER, DDS, P.C.
Entity type:Organization
Organization Name:KELLY ANNE SNYDER, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-694-4700
Mailing Address - Street 1:2101 AURELIUS RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1380
Mailing Address - Country:US
Mailing Address - Phone:517-694-4700
Mailing Address - Fax:
Practice Address - Street 1:2101 AURELIUS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1380
Practice Address - Country:US
Practice Address - Phone:517-694-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010186141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty