MEDICARE: TODD C SNYDER DDS A PROFESSIONAL CORPORATION

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	261QD0000X	Dental Clinic/Center	41870	CA
2	122300000X	Dentist	41870	CA

General Provider Information

NPI Number	:	1134260458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TODD C SNYDER DDS A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	25500 RANCHO NIGUEL RD
Second Line	:	# 230
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-7302
Country	:	US
Telephone Number	:	949-643-6733
Fax Number	:	949-643-6731

Provider Business Practice Location Address
First Line	:	25500 RANCHO NIGUEL RD
Second Line	:	# 230
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-7302
Country	:	US
Telephone Number	:	949-643-6733
Fax Number	:	949-643-6731

Authorized Official
Title or Position	:	CEO
Name	:	DR. TODD C SNYDER
Credential	:	DDS
Telephone Number	:	949-643-6733

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	12/30/2014

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