Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 37921 | CA |
NPI | 1003028697 |
---|---|
Provider Name | Dr. Kevin John Snaer |
First Address | Arcadia, CA 91007-6377 |
Second Address | Arcadia, CA 91007-6377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37921 | STATE DENTAL LICENSE (01) | CA |