Provider Demographics
NPI:1558639468
Name:SPEER, KEVIN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:H
Last Name:SPEER
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 1:12686 SE MEADEHILL AVE
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4404
Mailing Address - Country:US
Mailing Address - Phone:503-803-3803
Mailing Address - Fax:
Practice Address - Street 1:2250 SE OAK GROVE BLVD
Practice Address - Street 2:STE A
Practice Address - City:OAK GROVE
Practice Address - State:OR
Practice Address - Zip Code:97267-2670
Practice Address - Country:US
Practice Address - Phone:503-654-9521
Practice Address - Fax:503-654-1695
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice