Provider Demographics
NPI:1215671417
Name:SNIDER, VIVIAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:SNIDER
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N HOFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-3607
Mailing Address - Country:US
Mailing Address - Phone:719-244-1548
Mailing Address - Fax:
Practice Address - Street 1:80 WILLOW PEAK DR UNIT D
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9827
Practice Address - Country:US
Practice Address - Phone:406-920-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-24
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-259471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty