Healthcare Provider Details

I. General information

NPI: 1285207712
Provider Name (Legal Business Name): SETH SNYDER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2D DENBN/NDC, PSC 20130 315 MCHUGH BLVD
CAMP LEJEUNE NC
28542-0130
US

IV. Provider business mailing address

2D DENBN/NDC, PSC 20130 315 MCHUGH BLVD
CAMP LEJEUNE NC
28542-0130
US

V. Phone/Fax

Practice location:
  • Phone: 910-451-2208
  • Fax:
Mailing address:
  • Phone: 910-451-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9902
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: