Provider Demographics
NPI:1962517037
Name:SNYDER, MARY A (DDS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:SNYDER
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 1:202 W WALNUT
Mailing Address - Street 2:
Mailing Address - City:ST PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082
Mailing Address - Country:US
Mailing Address - Phone:507-934-2231
Mailing Address - Fax:507-934-2246
Practice Address - Street 1:202 W WALNUT
Practice Address - Street 2:
Practice Address - City:ST PETER
Practice Address - State:MN
Practice Address - Zip Code:56082
Practice Address - Country:US
Practice Address - Phone:507-934-2231
Practice Address - Fax:507-934-2246
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist