Provider Demographics
NPI:1164450276
Name:SNOW, SUZANNE R (DDS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:SNOW
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 1:90 COLUMBIA POINT DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4375
Mailing Address - Country:US
Mailing Address - Phone:509-946-9313
Mailing Address - Fax:509-628-5233
Practice Address - Street 1:90 COLUMBIA POINT DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4375
Practice Address - Country:US
Practice Address - Phone:509-946-9313
Practice Address - Fax:509-628-5233
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
BS9283881OtherDEA