MEDICARE: RYAN LEE SNYDER DMD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS031122L	PA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	23585	TX

General Provider Information

NPI Number	:	1568555654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN LEE SNYDER DMD

Provider Business Mailing Address
First Line	:	1703 MERRITT PARK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-6589
Country	:	US
Telephone Number	:	542-585-8252
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 PEPPERRELL ST BLDG 3352
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-5313
Country	:	US
Telephone Number	:	210-292-9053
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	06/30/2022

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