MEDICARE: KRISTINA SNYDER

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	RES.004251	OH

General Provider Information

NPI Number	:	1609491588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA SNYDER

Provider Business Mailing Address
First Line	:	5476 STRATHAVEN DR
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-1970
Country	:	US
Telephone Number	:	440-915-4746
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 BRAINARD RD STE 3
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-3145
Country	:	US
Telephone Number	:	440-421-9650
Fax Number	:

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

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	07/08/2021

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