Healthcare Provider Details

I. General information

NPI: 1134260458
Provider Name (Legal Business Name): TODD C SNYDER DDS A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 RANCHO NIGUEL RD # 230
LAGUNA NIGUEL CA
92677-7302
US

IV. Provider business mailing address

25500 RANCHO NIGUEL RD # 230
LAGUNA NIGUEL CA
92677-7302
US

V. Phone/Fax

Practice location:
  • Phone: 949-643-6733
  • Fax: 949-643-6731
Mailing address:
  • Phone: 949-643-6733
  • Fax: 949-643-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41870
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number41870
License Number StateCA

VIII. Authorized Official

Name: DR. TODD C SNYDER
Title or Position: CEO
Credential: DDS
Phone: 949-643-6733