Healthcare Provider Details

I. General information

NPI: 1649311408
Provider Name (Legal Business Name): THOMAS DEAN SNARR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S CENTER ST
REXBURG ID
83440-1916
US

IV. Provider business mailing address

4368 JUD ST
REXBURG ID
83440-4380
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-4240
  • Fax:
Mailing address:
  • Phone: 208-359-2466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD3021
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: