Provider Demographics
NPI:1528443322
Name:JACKIE SNAPP, DDS, PLLC
Entity type:Organization
Organization Name:JACKIE SNAPP, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-503-0885
Mailing Address - Street 1:PO BOX 1151
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20307 VIKING AVE NW
Practice Address - Street 2:SUITE 201
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8321
Practice Address - Country:US
Practice Address - Phone:425-503-0885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60575813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty