Healthcare Provider Details

I. General information

NPI: 1205052974
Provider Name (Legal Business Name): GARY J SNYDER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 CAMBRIDGE MANOR PL
FORT MYERS FL
33907-3620
US

IV. Provider business mailing address

1315 SHADOW LN
FORT MYERS FL
33901-7734
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-0597
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN7367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: