Healthcare Provider Details

I. General information

NPI: 1770781189
Provider Name (Legal Business Name): MATTHEW R. SNIPES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N. HIGH STREET SUITE 403
COLUMBUS OH
43215
US

IV. Provider business mailing address

10 N. HIGH STREET SUITE 403
COLUMBUS OH
43215
US

V. Phone/Fax

Practice location:
  • Phone: 614-223-1000
  • Fax: 614-223-1001
Mailing address:
  • Phone: 614-223-1000
  • Fax: 614-223-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-022583
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: