Provider Demographics
NPI:1205839073
Name:SPEICHER, MARY A (DMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:SPEICHER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7519 LAKE MANASSAS DRIVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155
Mailing Address - Country:US
Mailing Address - Phone:703-743-5937
Mailing Address - Fax:
Practice Address - Street 1:7915 LAKE MANASSAS DR
Practice Address - Street 2:SUITE 115
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3258
Practice Address - Country:US
Practice Address - Phone:571-261-9470
Practice Address - Fax:571-261-9472
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0401007331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist