Healthcare Provider Details

I. General information

NPI: 1851453369
Provider Name (Legal Business Name): ORAL & MAXILLOFACIAL SURGERY ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E 11TH ST SUITE 201
SPENCER IA
51301-4364
US

IV. Provider business mailing address

116 E 11TH ST SUITE 201
SPENCER IA
51301-4364
US

V. Phone/Fax

Practice location:
  • Phone: 712-262-7350
  • Fax: 712-262-7351
Mailing address:
  • Phone: 712-262-7350
  • Fax: 712-262-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN BENJAMIN SYNHORST II
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 712-262-7350