Individual
DR. RUSSELL EVANS SPEER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
564 W 25TH ST, MERCED, CA 95340-2828
(209) 722-6257
Mailing address
564 W 25TH ST, MERCED, CA 95340-2828
(209) 722-6257
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
26788
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
887064
UNITED CONCORDIA TRICARE
PA
05
—
D26788
—
CA
01
—
G9217501
MEDICAL BILLING PROVIDER
CA
Enumeration date
11/08/2005
Last updated
07/08/2007
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