Provider Demographics
NPI:1720308497
Name:SNOW, CHRISTINE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:SNOW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18227 HARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2127
Mailing Address - Country:US
Mailing Address - Phone:708-799-5162
Mailing Address - Fax:708-799-5344
Practice Address - Street 1:9501 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1429
Practice Address - Country:US
Practice Address - Phone:708-799-5162
Practice Address - Fax:708-799-5344
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0281971223G0001X
IN12011913A1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201137880Medicaid