Provider Demographics
NPI:1245433044
Name:SNELL-KILLAM, AIMEE NICOLE (DDS, MS)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:NICOLE
Last Name:SNELL-KILLAM
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1789 COLLEGE PKWY
Mailing Address - Street 2:STE 121
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7997
Mailing Address - Country:US
Mailing Address - Phone:775-887-9453
Mailing Address - Fax:775-887-8915
Practice Address - Street 1:1789 COLLEGE PKWY
Practice Address - Street 2:STE 110
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7997
Practice Address - Country:US
Practice Address - Phone:775-887-9453
Practice Address - Fax:775-887-8915
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2901019321122300000X, 1223G0001X
NV57941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1245433044Medicaid