MEDICARE: TAYLOR N SNIDER 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	122300000X	Dentist	APPLYING	MA

General Provider Information

NPI Number	:	1790272904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR N SNIDER DMD

Provider Business Mailing Address
First Line	:	91 FERNCROFT RD
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-2635
Country	:	US
Telephone Number	:	978-867-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 N LAKE SHORE DR APT 20G
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5233
Country	:	US
Telephone Number	:	256-738-6288
Fax Number	:

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

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	03/30/2021

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