Healthcare Provider Details

I. General information

NPI: 1124122734
Provider Name (Legal Business Name): SPRINGFIELD ASSOCIATES IN ORAL & MAXILLOFACIAL SURGERY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 SPRING MILL DR
SPRINGFIELD IL
62704-6558
US

IV. Provider business mailing address

3007 SPRING MILL DR
SPRINGFIELD IL
62704-6558
US

V. Phone/Fax

Practice location:
  • Phone: 217-546-8100
  • Fax:
Mailing address:
  • Phone: 217-546-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. PHILLIP NEWTON WHEAT
Title or Position: ORAL SURGEON
Credential: DDS
Phone: 217-546-8100