Healthcare Provider Details

I. General information

NPI: 1497154231
Provider Name (Legal Business Name): TIMOTHY LAWRENCE SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TIMOTHY LAWRENCE SNYDER DDS

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 DEL PRADO BLVD SOUTH
CAPE CORAL FL
33904
US

IV. Provider business mailing address

4113 DEL PRADO BLVD SOUTH
CAPE CORAL FL
33904
US

V. Phone/Fax

Practice location:
  • Phone: 239-540-1117
  • Fax: 239-540-1119
Mailing address:
  • Phone: 239-540-1117
  • Fax: 239-540-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN8756
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: