Provider Demographics
NPI:1548540123
Name:SNOW & SHAPLEY DENTAL OFFICE INC
Entity type:Organization
Organization Name:SNOW & SHAPLEY DENTAL OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-224-4225
Mailing Address - Street 1:2176 SUNSET CLIFFS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2119
Mailing Address - Country:US
Mailing Address - Phone:619-224-4225
Mailing Address - Fax:619-523-8607
Practice Address - Street 1:2176 SUNSET CLIFFS BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2119
Practice Address - Country:US
Practice Address - Phone:619-224-4225
Practice Address - Fax:619-523-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty