Provider Demographics
NPI:1316244767
Name:SNYDER, CRAIG BRADLEY (DDS)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:BRADLEY
Last Name:SNYDER
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 1:18340 GOVERNORS HWY
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2910
Mailing Address - Country:US
Mailing Address - Phone:708-799-0660
Mailing Address - Fax:708-798-9908
Practice Address - Street 1:18340 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2910
Practice Address - Country:US
Practice Address - Phone:708-799-0660
Practice Address - Fax:708-798-9908
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190258171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice