Healthcare Provider Details

I. General information

NPI: 1538568514
Provider Name (Legal Business Name): TERRANCE WARREN SNYDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 HAWK LNDG
FRUITLAND PARK FL
34731-6537
US

IV. Provider business mailing address

907 HAWK LNDG
FRUITLAND PARK FL
34731-6537
US

V. Phone/Fax

Practice location:
  • Phone: 352-410-6110
  • Fax:
Mailing address:
  • Phone: 352-410-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS018586L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: