Provider Demographics
NPI:1326199506
Name:SNODY, LEANN KOLB (DDS)
Entity type:Individual
Prefix:DR
First Name:LEANN
Middle Name:KOLB
Last Name:SNODY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHERRY
Other - Middle Name:LEANN
Other - Last Name:SNODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:1210 GREGORY ST. STE.#3
Mailing Address - City:TAFT
Mailing Address - State:TX
Mailing Address - Zip Code:78390-0212
Mailing Address - Country:US
Mailing Address - Phone:361-528-3262
Mailing Address - Fax:361-528-2016
Practice Address - Street 1:1210 GREGORY ST STE 3
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:TX
Practice Address - Zip Code:78390-3045
Practice Address - Country:US
Practice Address - Phone:361-528-3262
Practice Address - Fax:361-528-0216
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1507675-02Medicaid
TX1385673OtherTRICARE