MEDICARE: SPECK ORTHODONTICS PA

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4683	TX
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	12153	TX

General Provider Information

NPI Number	:	1275646895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECK ORTHODONTICS PA

Provider Business Mailing Address
First Line	:	5335 EDLOE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005
Country	:	US
Telephone Number	:	713-668-6778
Fax Number	:	713-668-0702

Provider Business Practice Location Address
First Line	:	5335 EDLOE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005
Country	:	US
Telephone Number	:	713-668-6778
Fax Number	:	713-668-0702

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DON T SPECK
Credential	:	DDS
Telephone Number	:	713-668-6778

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/31/2015

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Directions to “SPECK ORTHODONTICS PA ” Practice Location

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