Provider Demographics
NPI:1962085985
Name:MARY ELLEN SNYDER, DDS, PC
Entity type:Organization
Organization Name:MARY ELLEN SNYDER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-844-6000
Mailing Address - Street 1:70 E 91ST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1550
Mailing Address - Country:US
Mailing Address - Phone:317-844-6000
Mailing Address - Fax:317-844-7321
Practice Address - Street 1:70 E 91ST ST STE 103
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1550
Practice Address - Country:US
Practice Address - Phone:317-844-6000
Practice Address - Fax:317-844-7321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty