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General NPI Number Information
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NPI Number | 1386009785
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Entity Type | Organization
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Legal Business Name | SUSAN E SNYDER DDS, PC
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 750 PARK EAST BLVD SUITE 5
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City | LAFAYETTE
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State | IN
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Zip | 47905-0788
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Country | US
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Telephone | 765-447-7878
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Fax | 765-449-0665
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Provider Business Mailing Address
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Address Line | 750 PARK EAST BLVD SUITE 5
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City | LAFAYETTE
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State | IN
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Zip | 47905-0788
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Country | US
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Telephone | 765-447-7878
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Fax | 765-449-0665
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN E SNYDER
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Credential |
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Telephone | 765-447-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12009083
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License Number State | IN
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