Healthcare Provider Details

I. General information

NPI: 1982717831
Provider Name (Legal Business Name): JOHN J SNYDER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17675 SW TUALATIN VALLEY HWY
BEAVERTON OR
97006
US

IV. Provider business mailing address

500 NE MULTNOMAH ST SUITE 100
PORTLAND OR
97232-2099
US

V. Phone/Fax

Practice location:
  • Phone: 503-259-3160
  • Fax:
Mailing address:
  • Phone: 503-813-4970
  • Fax: 503-813-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6388
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00008584
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: