Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 19876 | OH |
NPI | 1013002989 |
---|---|
Provider Name | Phil J Snyder |
First Address | Boardman, OH 44512 |
Second Address | Boardman, OH 44512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 18/05/2016 |