Healthcare Provider Details

I. General information

NPI: 1699679209
Provider Name (Legal Business Name): SNOWFLAKE FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 S MAIN ST STE C
SNOWFLAKE AZ
85937-5585
US

IV. Provider business mailing address

932 S MAIN ST STE C
SNOWFLAKE AZ
85937-5585
US

V. Phone/Fax

Practice location:
  • Phone: 928-536-5773
  • Fax: 928-536-5776
Mailing address:
  • Phone: 928-536-5773
  • Fax: 928-536-5776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BRYCE JONES
Title or Position: OWNER
Credential: DMD
Phone: 925-536-5773