Healthcare Provider Details

I. General information

NPI: 1659203537
Provider Name (Legal Business Name): JEFFREY JOSEPH SPEAK RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E GREGORY BLVD
KANSAS CITY MO
64114-1117
US

IV. Provider business mailing address

19 E GREGORY BLVD
KANSAS CITY MO
64114-1117
US

V. Phone/Fax

Practice location:
  • Phone: 816-603-1737
  • Fax:
Mailing address:
  • Phone: 816-603-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2019020307
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: