Healthcare Provider Details

I. General information

NPI: 1598102675
Provider Name (Legal Business Name): ALLEN SNYDER RUANE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3159 RAWLE ST GROUND FLOOR
PHILADELPHIA PA
19149-2618
US

IV. Provider business mailing address

3159 RAWLE ST GROUND FLOOR
PHILADELPHIA PA
19149-2618
US

V. Phone/Fax

Practice location:
  • Phone: 215-333-1770
  • Fax:
Mailing address:
  • Phone: 215-333-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS022340L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: