Healthcare Provider Details

I. General information

NPI: 1780609412
Provider Name (Legal Business Name): EDWARD PHILIP SNYDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CLEVELAND AVE STE 6
MARTINSVILLE VA
24112-3700
US

IV. Provider business mailing address

101 CLEVELAND AVE STE 6
MARTINSVILLE VA
24112-3700
US

V. Phone/Fax

Practice location:
  • Phone: 276-632-4144
  • Fax: 276-632-9083
Mailing address:
  • Phone: 276-632-4144
  • Fax: 276-632-9083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0401-005991
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: