Provider Demographics
NPI:1285794214
Name:SNYDER, JULIA TYSON (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:TYSON
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:ANN
Other - Last Name:TYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:450 NEW MARKET BLVD
Mailing Address - Street 2:STE. 2
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-265-1112
Mailing Address - Fax:828-265-2836
Practice Address - Street 1:450 NEW MARKET BLVD
Practice Address - Street 2:STE. 2
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-265-1112
Practice Address - Fax:828-265-2836
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1891873097Medicaid