MEDICARE: DR. STEVEN SPEAKER D.D.S.

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	122300000X	Dentist	6686	NV

General Provider Information

NPI Number	:	1063883965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN SPEAKER D.D.S.

Provider Business Mailing Address
First Line	:	700 CARNEGIE ST
Second Line	:	APT 3513
City	:	HENDERSON
State	:	NV
Zip	:	89052-2680
Country	:	US
Telephone Number	:	951-880-8255
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 SUNSET WAY
Second Line	:	BUILDING C
City	:	HENDERSON
State	:	NV
Zip	:	89014-2015
Country	:	US
Telephone Number	:	702-968-5222
Fax Number	:

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

Provider Enumeration Date	:	10/18/2015
Last Update Date	:	10/18/2015

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