Healthcare Provider Details

I. General information

NPI: 1164415527
Provider Name (Legal Business Name): TIMOTHY C SNYDER DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 WHISPERING PINES LN STE 3
GRASS VALLEY CA
95945-5975
US

IV. Provider business mailing address

1364 WHISPERING PINES LN STE 3
GRASS VALLEY CA
95945-5975
US

V. Phone/Fax

Practice location:
  • Phone: 530-272-3111
  • Fax: 530-272-4111
Mailing address:
  • Phone: 530-272-3111
  • Fax: 530-272-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number33993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: