Provider Demographics
NPI:1215028857
Name:SPEER, WALTER BRADEN (DDS MSD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:BRADEN
Last Name:SPEER
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13601 PRESTON ROAD
Mailing Address - Street 2:301 WEST CARILLON TOWER
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240
Mailing Address - Country:US
Mailing Address - Phone:972-387-0746
Mailing Address - Fax:972-387-0765
Practice Address - Street 1:13601 PRESTON ROAD
Practice Address - Street 2:301 WEST CARILLON TOWER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-387-0746
Practice Address - Fax:972-387-0765
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics