Provider Demographics
NPI:1730201534
Name:SNOW, KENRIC ANDERSON (DDS)
Entity type:Individual
Prefix:
First Name:KENRIC
Middle Name:ANDERSON
Last Name:SNOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SIERRA GATE PLZ
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6645
Mailing Address - Country:US
Mailing Address - Phone:916-784-9191
Mailing Address - Fax:
Practice Address - Street 1:10 SIERRA GATE PLZ
Practice Address - Street 2:SUITE 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6645
Practice Address - Country:US
Practice Address - Phone:916-784-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA453241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice