Healthcare Provider Details

I. General information

NPI: 1598003261
Provider Name (Legal Business Name): LUISA SNYDER D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 COMMERCIAL ST. S.E.
SALEM OR
97302
US

IV. Provider business mailing address

1524 COMMERCIAL ST. S.E.
SALEM OR
97302
US

V. Phone/Fax

Practice location:
  • Phone: 503-362-8364
  • Fax: 503-378-0853
Mailing address:
  • Phone: 503-362-8364
  • Fax: 503-378-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10063
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: