Healthcare Provider Details

I. General information

NPI: 1700185634
Provider Name (Legal Business Name): SNELSON & SNELSON, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 E MARKET ST
WARREN OH
44484-4736
US

IV. Provider business mailing address

3919 E MARKET ST
WARREN OH
44484-4736
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-1433
  • Fax: 330-856-3911
Mailing address:
  • Phone: 330-856-1433
  • Fax: 330-856-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11913
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. RALPH E. SNELSON
Title or Position: PARTNER
Credential: DDS
Phone: 330-856-1433