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General NPI Number Information
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NPI Number | 1770713265
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Entity Type | Organization
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Legal Business Name | ENDODONTICS SOUTH, LTD
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 07/20/2009
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Provider Practice Location Address
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Address Line | 1431 US HWY 61 SO
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City | FESTUS
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State | MO
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Zip | 63028
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Country | US
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Telephone | 636-933-7001
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Fax | 636-933-7002
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Provider Business Mailing Address
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Address Line | 1431 US HIGHWAY 61
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City | FESTUS
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State | MO
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Zip | 63028-4109
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Country | US
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Telephone | 636-933-7001
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Fax | 636-933-7002
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARVIN LEIGH SPEER
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Credential | DDS MS
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Telephone | 636-933-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 012432
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License Number State | MO
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