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NPI Code Detail

MEDICARE: DR. CHARLES JOSEPH SNYDER D.M.D.

MEDICARE: DR. CHARLES JOSEPH SNYDER D.M.D.
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
11223P0700XProsthodonticsDS025310LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DSO25310LOTHERPALICENSE NUMBER

General Provider Information

NPI Number : 1841275948
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES JOSEPH SNYDER D.M.D.
Provider Business Mailing Address
First Line : 19 TRADEWINDS DR
Second Line :
City : CABOT
State : AR
Zip : 72023-7057
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1090 ARNOLD DR
Second Line :
City : LITTLE ROCK AIR FORCE BASE
State : AR
Zip : 72099-4933
Country : US
Telephone Number : 501-987-7304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2005
Last Update Date : 06/16/2018

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