Provider Demographics
NPI:1407904519
Name:SPECK, MARK LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEE
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 1:3131 EASTSIDE ST STE 470
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1919
Mailing Address - Country:US
Mailing Address - Phone:713-528-6684
Mailing Address - Fax:713-522-4023
Practice Address - Street 1:3131 EASTSIDE ST STE 470
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1919
Practice Address - Country:US
Practice Address - Phone:713-528-6684
Practice Address - Fax:713-522-4023
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice