MEDICARE: DR. EDWARD PHILIP SNYDER D.D.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	174400000X	Specialist	0401-005991	VA

General Provider Information

NPI Number	:	1780609412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD PHILIP SNYDER D.D.S.

Provider Business Mailing Address
First Line	:	101 CLEVELAND AVE STE 6
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-3700
Country	:	US
Telephone Number	:	276-632-4144
Fax Number	:	276-632-9083

Provider Business Practice Location Address
First Line	:	101 CLEVELAND AVE STE 6
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-3700
Country	:	US
Telephone Number	:	276-632-4144
Fax Number	:	276-632-9083

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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