Healthcare Provider Details

I. General information

NPI: 1063883965
Provider Name (Legal Business Name): STEVEN SPEAKER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2015
Last Update Date: 10/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SUNSET WAY BUILDING C
HENDERSON NV
89014-2015
US

IV. Provider business mailing address

700 CARNEGIE ST APT 3513
HENDERSON NV
89052-2680
US

V. Phone/Fax

Practice location:
  • Phone: 702-968-5222
  • Fax:
Mailing address:
  • Phone: 951-880-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6686
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: