Healthcare Provider Details

I. General information

NPI: 1316961121
Provider Name (Legal Business Name): DAVID MARK SNYDERMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MONTAUK AVE SUITE 102
NEW LONDON CT
06320-4906
US

IV. Provider business mailing address

15 APPLEWOOD DR
QUAKER HILL CT
06375-1331
US

V. Phone/Fax

Practice location:
  • Phone: 860-447-9280
  • Fax: 860-437-1938
Mailing address:
  • Phone: 860-442-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number008333
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: