Provider Demographics
NPI:1083838965
Name:SPECK, STEPHEN MITCHELL (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MITCHELL
Last Name:SPECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4047 TWIN OAKS LANE
Mailing Address - Street 2:
Mailing Address - City:CANE RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076
Mailing Address - Country:US
Mailing Address - Phone:615-641-7001
Mailing Address - Fax:615-871-0988
Practice Address - Street 1:3515 CENTRAL PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076
Practice Address - Country:US
Practice Address - Phone:615-883-3450
Practice Address - Fax:615-871-0988
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice