Individual provider Active NPI

Erik Mathew Snell, D.D.S.

  • Dentist
  • Liberty Township, OH
National Provider Identifier
1124464342
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
30.023947 Issued in OH
Practice address
5307 Hildenbrand Way
Liberty Township, OH 45011
Phone
(513) 759-7635
Fax
(513) 755-2039
NPI assigned
May 14, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30.023947 OH Primary

Addresses

Primary practice location

5307 Hildenbrand Way
Liberty Township, OH 45011

Mailing address

5307 Hildenbrand Way
Liberty Township, OH 45011
Phone (513) 759-7635

Other practice location 1

5307 Hildenbrand Way
Liberty Township, OH 45011
Phone (513) 759-7635

Other identifiers 1

IdentifierTypeStateIssuer
01014785MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150717001840 OH Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5193038255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Erik Snell Dentistry Evolved LLC CurrentSince Nov 10, 2024 Accepting new patients

Locations

7570 Bales St
Ste 370
Liberty Township, OH 45069

5307 Hildenbrand Way
Liberty Twp, OH 45011
Phone (513) 759-7635

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1124464342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5307 HILDENBRAND WAY",
            "city": "LIBERTY TOWNSHIP",
            "state": "OH",
            "postal_code": "45011",
            "telephone_number": "513-759-7635",
            "fax_number": "513-755-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5307 HILDENBRAND WAY",
            "city": "LIBERTY TOWNSHIP",
            "state": "OH",
            "postal_code": "45011",
            "telephone_number": "513-759-7635",
            "fax_number": "513-755-2039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5307 Hildenbrand Way",
            "address_purpose": "LOCATION",
            "city": "Liberty Township",
            "state": "OH",
            "postal_code": "45011",
            "country_code": "US",
            "telephone_number": "513-759-7635",
            "fax_number": "513-755-2039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SNELL",
        "first_name": "ERIK",
        "middle_name": "MATHEW",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-14",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.023947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01014785",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty Township, OH

Sources for this page

Verify at the official NPI Registry.