MEDICARE: DR. RAY D SNIDER D.D.S., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12073	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D12073	OTHER	TX	BC/BS PROVIDER #
2	841904	OTHER	TX	UNITED CONCORDIAPROVIDER#

General Provider Information

NPI Number	:	1083703672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAY D SNIDER D.D.S., P.A.

Provider Business Mailing Address
First Line	:	8509 WOODLAKE CIR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3143
Country	:	US
Telephone Number	:	817-236-1949
Fax Number	:

Provider Business Practice Location Address
First Line	:	8461 BOAT CLUB RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3607
Country	:	US
Telephone Number	:	817-236-8771
Fax Number	:	817-236-8791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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