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General NPI Number Information
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NPI Number | 1477893485
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Entity Type | Individual
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Provider Name | DEREK SNARE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 4175 S ALAMO AVE BLDG 400
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City | DAVIS MONTHAN AFB
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State | AZ
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Zip | 85707-4402
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Country | US
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Telephone | 520-228-1559
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Fax |
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Provider Business Mailing Address
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Address Line | 4175 S ALAMO AVE BLDG 400
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City | DAVIS MONTHAN AFB
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State | AZ
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Zip | 85707-4402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | D009900
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License Number State | AZ
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