Healthcare Provider Details

I. General information

NPI: 1245813872
Provider Name (Legal Business Name): EMILY JO SNODGRASS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 BIELENBERG DR STE 160
WOODBURY MN
55125-1405
US

IV. Provider business mailing address

748 BIELENBERG DR STE 160
WOODBURY MN
55125-1405
US

V. Phone/Fax

Practice location:
  • Phone: 651-233-2140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD15261
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: