=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730272253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPRING DENTAL GROUP, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5440 SPRING STREET
-----------------------------------------------------
City | RACINE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53406-2912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-886-9440
-----------------------------------------------------
Fax | 262-886-9457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5440 SPRING STREET
-----------------------------------------------------
City | RACINE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53406-2912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-886-9440
-----------------------------------------------------
Fax | 262-886-9457
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NED J MURPHY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 262-886-9440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 5000198
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------