Healthcare Provider Details

I. General information

NPI: 1275610297
Provider Name (Legal Business Name): KEITH D SNITKER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 GILLHAM PLZ
KANSAS CITY MO
64109-1745
US

IV. Provider business mailing address

3315 GILLHAM PLZ
KANSAS CITY MO
64109-1745
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-2273
  • Fax:
Mailing address:
  • Phone: 816-561-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20442
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2011026384
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: