Healthcare Provider Details

I. General information

NPI: 1356417307
Provider Name (Legal Business Name): GLENN DAVID SNYDER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 ARDMORE BLVD SUITE 150
PITTSBURGH PA
15221-4652
US

IV. Provider business mailing address

2030 ARDMORE BLVD SUITE 150
PITTSBURGH PA
15221-4652
US

V. Phone/Fax

Practice location:
  • Phone: 412-271-5050
  • Fax: 412-271-5051
Mailing address:
  • Phone: 412-271-5050
  • Fax: 412-271-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS024153L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: