Healthcare Provider Details

I. General information

NPI: 1609491588
Provider Name (Legal Business Name): KRISTINA SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BRAINARD RD STE 3
HIGHLAND HEIGHTS OH
44143-3145
US

IV. Provider business mailing address

5476 STRATHAVEN DR
HIGHLAND HEIGHTS OH
44143-1970
US

V. Phone/Fax

Practice location:
  • Phone: 440-421-9650
  • Fax:
Mailing address:
  • Phone: 440-915-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberRES.004251
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: