Healthcare Provider Details

I. General information

NPI: 1184859670
Provider Name (Legal Business Name): SCOTT ANDREW SNYDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 84TH ST SW
BYRON CENTER MI
49315-9230
US

IV. Provider business mailing address

2700 84TH ST SW P.O. BOX 254
BYRON CENTER MI
49315-9230
US

V. Phone/Fax

Practice location:
  • Phone: 616-878-1675
  • Fax: 616-878-0786
Mailing address:
  • Phone: 616-878-1675
  • Fax: 616-878-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901020012
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: