Spring Park Oral and Maxillofacial Surgeons, P.C.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

8664 Issued in IA

Legal business name

SPRING PARK ORAL AND MAXILLOFACIAL SURGEONS, P.C.

Practice address

1111 Canal Shore Dr SW
Le Claire, IA 52753-7602

Phone

(563) 355-1034

NPI assigned

Feb 4, 2014

Last updated

Apr 29, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Paul R Smith, DDSNPI 1174582928

Title

President/Owner

Phone

(563) 359-1601

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paul R Smith, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Davenport, IA
  • NPI 1174582928
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398729600000",
    "number": "1386067817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5345 SPRING ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072764",
            "telephone_number": "563-359-1601",
            "fax_number": "563-355-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 CANAL SHORE DR SW",
            "city": "LE CLAIRE",
            "state": "IA",
            "postal_code": "527537602",
            "telephone_number": "563-355-1034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRING PARK ORAL AND MAXILLOFACIAL SURGEONS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-04",
        "last_updated": "2014-04-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "563-359-1601",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IA",
            "license": "8664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "87346",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Shaw, PA-C
• Shepherd Chiropractic PLLC
• Ronald G Shepherd, D.C.
• Charles A Smith, DO
• Michelle M Sprengelmeyer, MD
• Michael T. Stecher, D.D.S.
• Rachel Anne Thennes, OTR/L
• Vanduyne Chiropractic PLC
• Joseph Douglas Vanduyne
• Kathleen Becht Vickroy, FNP

• Dental Clinic/Center in Le Claire, IA
• Providers in Le Claire, IA by specialty
• Dental Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.