Provider Demographics
NPI:1396342465
Name:KEVIN H. SPEER, PC
Entity type:Organization
Organization Name:KEVIN H. SPEER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SPEER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-803-3803
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
Mailing Address - Country:US
Mailing Address - Phone:503-654-9521
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
Practice Address - Country:US
Practice Address - Phone:503-654-9521
Practice Address - Fax:503-654-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty