Provider Demographics
NPI:1669588075
Name:SNYDER, STANLEY DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:DAVID
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 1:2825 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468
Mailing Address - Country:US
Mailing Address - Phone:660-582-8601
Mailing Address - Fax:660-582-8630
Practice Address - Street 1:2825 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468
Practice Address - Country:US
Practice Address - Phone:660-582-8601
Practice Address - Fax:660-582-8630
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0153691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice