Provider Demographics
NPI:1023157468
Name:SNITZER, RICHARD D (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:SNITZER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 N KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3914
Mailing Address - Country:US
Mailing Address - Phone:314-965-8283
Mailing Address - Fax:314-965-9105
Practice Address - Street 1:508 N KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-3914
Practice Address - Country:US
Practice Address - Phone:314-965-8283
Practice Address - Fax:314-965-9105
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO014727261QD0000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO402533715Medicaid