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General NPI Number Information
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NPI Number | 1649727876
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Entity Type | Organization
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Legal Business Name | DR. ERIK SNELL DENTISTRY EVOLVED LLC
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | PRIME DENTISTRY & IMPLANTS 5307 HILDENBRAND WAY
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City | LIBERTY TOWNSHP
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State | OH
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Zip | 45011
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Country | US
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Telephone | 513-759-7635
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Fax | 513-755-2039
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Provider Business Mailing Address
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Address Line | PRIME DENTISTRY & IMPLANTS 5307 HILDENBRAND WAY
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City | LIBERTY TOWNSHP
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State | OH
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Zip | 45011
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Country | US
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Telephone | 513-759-7635
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Fax | 513-755-2039
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. ERIK MATHEW SNELL
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Credential | D.D.S.
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Telephone | 937-604-7117
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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 | 30.023947
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License Number State | OH
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