Provider Demographics
NPI:1720142060
Name:SNELL, JERRY D II (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:D
Last Name:SNELL
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26245 HIGHWAY 82 STE 2
Mailing Address - Street 2:
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74451-2802
Mailing Address - Country:US
Mailing Address - Phone:918-458-5140
Mailing Address - Fax:918-458-5155
Practice Address - Street 1:26245 HIGHWAY 82 STE 2
Practice Address - Street 2:
Practice Address - City:PARK HILL
Practice Address - State:OK
Practice Address - Zip Code:74451-2802
Practice Address - Country:US
Practice Address - Phone:918-458-5140
Practice Address - Fax:918-458-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK54961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice