MEDICARE: AIMEE NICOLE SNELL-KILLAM D.D.S., M.S.

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	122300000X	Dentist	2901019321	MI
2	1223G0001X	General Practice Dentistry	2901019321	MI
3	1223P0221X	Pediatric Dentistry	5794	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245433044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE NICOLE SNELL-KILLAM D.D.S., M.S.

Provider Business Mailing Address
First Line	:	1789 COLLEGE PKWY
Second Line	:	STE 121
City	:	CARSON CITY
State	:	NV
Zip	:	89706-7997
Country	:	US
Telephone Number	:	775-887-9453
Fax Number	:	775-887-8915

Provider Business Practice Location Address
First Line	:	1789 COLLEGE PKWY
Second Line	:	STE 110
City	:	CARSON CITY
State	:	NV
Zip	:	89706-7997
Country	:	US
Telephone Number	:	775-887-9453
Fax Number	:	775-887-8915

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	09/28/2016

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