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General NPI Number Information
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NPI Number | 1336786300
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Entity Type | Organization
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Legal Business Name | JESSICA J SNELLER DDS PLLC
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 384 N THIRD AVE, SUITE A
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City | FRUITPORT
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State | MI
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Zip | 49415
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Country | US
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Telephone | 231-366-6081
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Fax | 231-366-6083
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Provider Business Mailing Address
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Address Line | 384 N THIRD AVE, SUITE A
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City | FRUITPORT
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State | MI
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Zip | 49415
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Country | US
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Telephone | 231-366-6081
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Fax | 231-366-6083
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Authorized Official
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Title or Position | OWNER
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Name | DR. JESSICA JEAN SNELLER
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Credential | DDS
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Telephone | 231-366-6081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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