Provider Demographics
NPI:1871722454
Name:SNYDER, KIMBALL (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBALL
Middle Name:
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E BOGARD RD STE B204
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6570
Mailing Address - Country:US
Mailing Address - Phone:907-376-9449
Mailing Address - Fax:
Practice Address - Street 1:1700 E BOGARD RD STE B204
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6570
Practice Address - Country:US
Practice Address - Phone:907-376-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-05
Last Update Date:2009-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK13041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice