Healthcare Provider Details

I. General information

NPI: 1225310469
Provider Name (Legal Business Name): MICAH L SNYDER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 NE RALPH POWELL RD
LEES SUMMIT MO
64064
US

IV. Provider business mailing address

3379 NE RALPH POWELL RD
LEES SUMMIT MO
64064
US

V. Phone/Fax

Practice location:
  • Phone: 816-787-8778
  • Fax: 816-272-0446
Mailing address:
  • Phone: 816-787-8778
  • Fax: 816-272-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number60856
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2011016319
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: