Healthcare Provider Details

I. General information

NPI: 1760029268
Provider Name (Legal Business Name): HARBOUR DENTAL CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SAN MARCO AVE
SAINT AUGUSTINE FL
32084-3257
US

IV. Provider business mailing address

75 SAN MARCO AVE
SAINT AUGUSTINE FL
32084-3257
US

V. Phone/Fax

Practice location:
  • Phone: 904-810-1002
  • Fax:
Mailing address:
  • Phone: 904-810-1002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN W SNYDER
Title or Position: PRESIDENT
Credential: DDS
Phone: 614-940-8243