Healthcare Provider Details

I. General information

NPI: 1134153281
Provider Name (Legal Business Name): ALVIN JEROME SNYDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N SAN MATEO DR #2
SAN MATEO CA
94401-2514
US

IV. Provider business mailing address

324 N SAN MATEO DR #2
SAN MATEO CA
94401-2514
US

V. Phone/Fax

Practice location:
  • Phone: 650-344-8818
  • Fax: 650-344-0296
Mailing address:
  • Phone: 650-344-8818
  • Fax: 650-344-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD20271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: