MEDICARE: R.SNITZER DENTAL, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	MO014727	MO

General Provider Information

NPI Number	:	1174511240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R.SNITZER DENTAL, L.L.C.

Provider Business Mailing Address
First Line	:	1714 OLIVE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1721
Country	:	US
Telephone Number	:	314-241-0885
Fax Number	:	314-241-0046

Provider Business Practice Location Address
First Line	:	1714 OLIVE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1721
Country	:	US
Telephone Number	:	314-241-0885
Fax Number	:	314-241-0046

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RICHARD D. SNITZER
Credential	:	D.M.D.
Telephone Number	:	314-241-0885

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	08/22/2020

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