Healthcare Provider Details

I. General information

NPI: 1861560526
Provider Name (Legal Business Name): THOMAS WILLIAM SNYDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 MAYFIELD RD STE 202
LYNDHURST OH
44124-2603
US

IV. Provider business mailing address

5035 MAYFIELD RD STE 202
LYNDHURST OH
44124-2603
US

V. Phone/Fax

Practice location:
  • Phone: 216-381-3381
  • Fax: 216-381-5357
Mailing address:
  • Phone: 216-381-3381
  • Fax: 216-381-5357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17690
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: