Healthcare Provider Details

I. General information

NPI: 1235354192
Provider Name (Legal Business Name): DONALD E. SNYDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 E SPRUCE AVE STE 102
FRESNO CA
93720-3371
US

IV. Provider business mailing address

1290 E SPRUCE AVE STE 102
FRESNO CA
93720-3371
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-5750
  • Fax: 559-431-5785
Mailing address:
  • Phone: 559-431-5750
  • Fax: 559-431-5785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number24407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: