Provider Demographics
NPI:1265825889
Name:SPECK ENDODONTICS, LLC
Entity Type:Organization
Organization Name:SPECK ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:HAINES
Authorized Official - Last Name:SPECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-542-2080
Mailing Address - Street 1:6470 TIPPIN AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8143
Mailing Address - Country:US
Mailing Address - Phone:850-969-1060
Mailing Address - Fax:850-969-9324
Practice Address - Street 1:6470 TIPPIN AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8143
Practice Address - Country:US
Practice Address - Phone:850-969-1060
Practice Address - Fax:850-969-9324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN210831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty