MEDICARE: DR. MARK LEE SPECK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	16940	TX

General Provider Information

NPI Number	:	1407904519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK LEE SPECK DDS

Provider Business Mailing Address
First Line	:	3131 EASTSIDE ST STE 470
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-1919
Country	:	US
Telephone Number	:	713-528-6684
Fax Number	:	713-522-4023

Provider Business Practice Location Address
First Line	:	3131 EASTSIDE ST STE 470
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-1919
Country	:	US
Telephone Number	:	713-528-6684
Fax Number	:	713-522-4023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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