Healthcare Provider Details

I. General information

NPI: 1801918271
Provider Name (Legal Business Name): SNYDER MCDOWELL DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
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

7711 CAMBRIDGE MANOR PL
FORT MYERS FL
33907-3620
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN7367
License Number StateFL

VIII. Authorized Official

Name: DR. GARY J SNYDER
Title or Position: PRESIDENT
Credential: DMD
Phone: 239-936-0597