Healthcare Provider Details

I. General information

NPI: 1285074625
Provider Name (Legal Business Name): ERIC SNYDER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2013
Last Update Date: 06/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12131 DORSETT RD
MARYLAND HEIGHTS MO
63043-2418
US

IV. Provider business mailing address

1064 NEWTON RD 10
IOWA CITY IA
52246-2291
US

V. Phone/Fax

Practice location:
  • Phone: 314-739-1222
  • Fax:
Mailing address:
  • Phone: 712-202-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2013020768
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: