Healthcare Provider Details

I. General information

NPI: 1477034700
Provider Name (Legal Business Name): KATIE LYNN SNAPP DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N MIDKIFF RD
MIDLAND TX
79701-2101
US

IV. Provider business mailing address

1509 SAN MIGUEL CT
MIDLAND TX
79705-2225
US

V. Phone/Fax

Practice location:
  • Phone: 432-897-0852
  • Fax:
Mailing address:
  • Phone: 405-706-6406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number34572
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: