Provider Demographics
NPI:1700264017
Name:GRANT SNIDER DDS, LLC
Entity Type:Organization
Organization Name:GRANT SNIDER DDS, LLC
Other - Org Name:DERBY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-260-6566
Mailing Address - Street 1:2701 NORTH ROCK ROAD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037
Mailing Address - Country:US
Mailing Address - Phone:316-260-6566
Mailing Address - Fax:
Practice Address - Street 1:2701 NORTH ROCK ROAD
Practice Address - Street 2:SUITE 600
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037
Practice Address - Country:US
Practice Address - Phone:316-260-6566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS609251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty