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General NPI Number Information
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NPI Number | 1649763475
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Entity Type | Individual
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Provider Name | MADALYN E SNYDER DMD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 482 BROWN BLVD
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2324
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Country | US
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Telephone | 815-939-2012
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Fax |
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Provider Business Mailing Address
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Address Line | 1893 INDIAN TRL
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City | KANKAKEE
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State | IL
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Zip | 60901-6251
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Country | US
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Telephone | 815-936-6461
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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 | 019.031616
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License Number State | IL
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