Provider Demographics
NPI:1457422008
Name:SNELL, STEPHEN GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GEORGE
Last Name:SNELL
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 1:12970 57TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1415
Mailing Address - Country:US
Mailing Address - Phone:763-559-1676
Mailing Address - Fax:
Practice Address - Street 1:404 1ST ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1602
Practice Address - Country:US
Practice Address - Phone:763-389-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice