Healthcare Provider Details

I. General information

NPI: 1194720243
Provider Name (Legal Business Name): STEPHEN CHARLES SNITZER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14377 WOODLAKE DR STE 214
CHESTERFIELD MO
63017-5735
US

IV. Provider business mailing address

14377 WOODLAKE DR STE 214
CHESTERFIELD MO
63017-5735
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-2101
  • Fax: 314-434-2361
Mailing address:
  • Phone: 314-434-2101
  • Fax: 314-434-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number13020
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: