MEDICARE: DR. DOUGLAS J SNYDER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12008732A	IN

General Provider Information

NPI Number	:	1134313778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS J SNYDER DDS

Provider Business Mailing Address
First Line	:	427 WATERFALL DR
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3660
Country	:	US
Telephone Number	:	574-293-9495
Fax Number	:	574-293-5721

Provider Business Practice Location Address
First Line	:	427 WATERFALL DR
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3660
Country	:	US
Telephone Number	:	574-293-9495
Fax Number	:	574-293-5721

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/28/2007

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