Individual
DR. DEIDRA JANIECE SNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
5800 RIDGEWOOD RD, SUITE 105, JACKSON, MS 39211-2667
(601) 398-2934
(769) 216-3311
Mailing address
5800 RIDGEWOOD RD, SUITE 105, JACKSON, MS 39211-2667
(601) 398-2934
(769) 216-3311
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3459-08
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811150766
—
MS
Enumeration date
07/09/2008
Last updated
10/11/2016
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