Provider Demographics
NPI:1063940294
Name:SNODGRASS, KATHERINE RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:RENEE
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:RENEE
Other - Last Name:HERIFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4117 NE EDGEWATER CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-3101
Mailing Address - Country:US
Mailing Address - Phone:816-591-8447
Mailing Address - Fax:
Practice Address - Street 1:324 S HUDSON ST
Practice Address - Street 2:
Practice Address - City:BUCKNER
Practice Address - State:MO
Practice Address - Zip Code:64016-8142
Practice Address - Country:US
Practice Address - Phone:816-249-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170164151223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health