Provider Demographics
NPI:1467455980
Name:SPECKER, LEWIS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEWIS L
Middle Name:
Last Name:SPECKER
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 1:180 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4205
Mailing Address - Country:US
Mailing Address - Phone:415-982-7443
Mailing Address - Fax:415-362-1321
Practice Address - Street 1:180 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4205
Practice Address - Country:US
Practice Address - Phone:415-982-7443
Practice Address - Fax:415-362-1321
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD235651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice