Healthcare Provider Details

I. General information

NPI: 1891796280
Provider Name (Legal Business Name): SNYDER DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 MAIN ST
SNYDER NY
14226-4567
US

IV. Provider business mailing address

4575 MAIN ST
SNYDER NY
14226-4567
US

V. Phone/Fax

Practice location:
  • Phone: 716-839-1470
  • Fax: 716-839-3484
Mailing address:
  • Phone: 716-839-1470
  • Fax: 716-839-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0456881
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0461691
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number024900
License Number StateNY

VIII. Authorized Official

Name: DR. I MARC SIEGEL
Title or Position: OWNER
Credential: DDS
Phone: 719-839-1470