=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023157468
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD D. SNITZER D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 03/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 508 N KIRKWOOD RD
-----------------------------------------------------
City | KIRKWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63122-3914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-965-8283
-----------------------------------------------------
Fax | 314-965-9105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 508 N KIRKWOOD RD
-----------------------------------------------------
City | KIRKWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63122-3914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-965-8283
-----------------------------------------------------
Fax | 314-965-9105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 014727
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 014727
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------