Provider Demographics
NPI:1225310469
Name:SNYDER, MICAH L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:L
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3379 NE RALPH POWELL RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064
Mailing Address - Country:US
Mailing Address - Phone:816-787-8778
Mailing Address - Fax:816-272-0446
Practice Address - Street 1:3379 NE RALPH POWELL RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064
Practice Address - Country:US
Practice Address - Phone:816-787-8778
Practice Address - Fax:816-272-0446
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60856122300000X
MO2011016319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist