Provider Demographics
NPI:1407733587
Name:SNOW PALMDALE DENTAL OFFICE INC.
Entity type:Organization
Organization Name:SNOW PALMDALE DENTAL OFFICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-609-0235
Mailing Address - Street 1:868 AUTO CENTER DR STE D
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4690
Mailing Address - Country:US
Mailing Address - Phone:661-945-2616
Mailing Address - Fax:
Practice Address - Street 1:868 AUTO CENTER DR STE D
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4690
Practice Address - Country:US
Practice Address - Phone:661-945-2616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty