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General NPI Number Information
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NPI Number | 1194784389
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Entity Type | Organization
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Legal Business Name | SPRING PARK ORAL AND MAXILLOFACIAL SURGEONS
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 407 S 4TH ST
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City | CLINTON
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State | IA
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Zip | 52732-4512
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Country | US
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Telephone | 563-243-4406
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Fax | 563-243-8534
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Provider Business Mailing Address
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Address Line | 407 S 4TH ST
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City | CLINTON
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State | IA
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Zip | 52732-4512
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Country | US
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Telephone | 563-243-4406
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Fax | 563-243-8534
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Authorized Official
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Title or Position | MANAGER
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Name | MARTIE TESHAK
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Credential |
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Telephone | 563-359-1601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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