MEDICARE: DOUGLAS J SNYDER DDS, PC

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	54000955A	IN

General Provider Information

NPI Number	:	1336333970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS J SNYDER DDS, PC

Provider Business Mailing Address
First Line	:	427 WATERFALL DR
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3660
Country	:	US
Telephone Number	:	574-293-9495
Fax Number	:

Provider Business Practice Location Address
First Line	:	427 WATERFALL DR
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3660
Country	:	US
Telephone Number	:	574-293-9495
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOUGLAS J SNYDER
Credential	:	DDS
Telephone Number	:	574-293-9495

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/28/2007

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