1295803245 NPI number — DR. WALTER J SNOW DMD

Table of content: DR. WALTER J SNOW DMD (NPI 1295803245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295803245 NPI number — DR. WALTER J SNOW DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNOW
Provider First Name:
WALTER
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SNOW
Provider Other First Name:
WALTER
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1295803245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7906
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORENO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92552-7906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-371-7200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 W 6TH ST STE 114
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92882-3066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-371-7200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  55517 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G8925701 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".