Provider Demographics
NPI:1124464342
Name:SNELL, ERIK MATHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:MATHEW
Last Name:SNELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 HILDENBRAND WAY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011
Mailing Address - Country:US
Mailing Address - Phone:513-759-7635
Mailing Address - Fax:513-755-2039
Practice Address - Street 1:5307 HILDENBRAND WAY
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011
Practice Address - Country:US
Practice Address - Phone:513-759-7635
Practice Address - Fax:513-755-2039
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01014785Medicaid