Provider Demographics
NPI:1851735880
Name:SPEIRS, CHAD (DMD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:SPEIRS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 KINGSTON ST UNIT 6B
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2225
Mailing Address - Country:US
Mailing Address - Phone:801-310-0797
Mailing Address - Fax:
Practice Address - Street 1:128A TREMONT ST FL 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4716
Practice Address - Country:US
Practice Address - Phone:617-432-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist