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General NPI Number Information
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NPI Number | 1760029268
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Entity Type | Organization
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Legal Business Name | HARBOUR DENTAL CARE, P.A.
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Dates
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Enumeration Date | 12/03/2019
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 75 SAN MARCO AVE
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-3257
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Country | US
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Telephone | 904-810-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 75 SAN MARCO AVE
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-3257
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Country | US
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Telephone | 904-810-1002
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN W SNYDER
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Credential | DDS
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Telephone | 614-940-8243
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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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