Provider Demographics
NPI:1538568514
Name:SNYDER, TERRANCE WARREN (DDS)
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:WARREN
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 1:907 HAWK LNDG
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-6537
Mailing Address - Country:US
Mailing Address - Phone:352-410-6110
Mailing Address - Fax:
Practice Address - Street 1:907 HAWK LNDG
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-6537
Practice Address - Country:US
Practice Address - Phone:352-410-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018586L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice