MEDICARE: DR. KEVIN H SPEER 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	1223G0001X	General Practice Dentistry	D8435	OR

General Provider Information

NPI Number	:	1558639468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN H SPEER D.D.S.

Provider Business Mailing Address
First Line	:	12686 SE MEADEHILL AVE
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-4404
Country	:	US
Telephone Number	:	503-803-3803
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 SE OAK GROVE BLVD
Second Line	:	STE A
City	:	OAK GROVE
State	:	OR
Zip	:	97267-2670
Country	:	US
Telephone Number	:	503-654-9521
Fax Number	:	503-654-1695

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

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	05/14/2016

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