Healthcare Provider Details

I. General information

NPI: 1770841900
Provider Name (Legal Business Name): TIMOTHY ROBERT SNYDER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 FRUITVILLE PIKE
LANCASTER PA
17601-4079
US

IV. Provider business mailing address

1801 FRUITVILLE PIKE
LANCASTER PA
17601-4079
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-7001
  • Fax:
Mailing address:
  • Phone: 717-569-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS037660
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: