Healthcare Provider Details

I. General information

NPI: 1558349647
Provider Name (Legal Business Name): RONALD P SNIDERMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 PONTIAC AVE SUITE 201
CRANSTON RI
02920-4455
US

IV. Provider business mailing address

1220 PONTIAC AVE SUITE 201
CRANSTON RI
02920-4455
US

V. Phone/Fax

Practice location:
  • Phone: 401-464-4540
  • Fax: 401-464-4870
Mailing address:
  • Phone: 401-464-4540
  • Fax: 401-464-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2098
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: