Provider Demographics
NPI:1700131331
Name:RIDER, ANNA ROSE SNYDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:ROSE SNYDER
Last Name:RIDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:ROSE
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1084 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-1735
Mailing Address - Country:US
Mailing Address - Phone:228-365-0301
Mailing Address - Fax:
Practice Address - Street 1:410 SECURITY SQ
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1952
Practice Address - Country:US
Practice Address - Phone:228-896-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3646-121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice