# SPRING PARK ORAL AND MAXILLOFACIAL SURGEONS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194784389
- **Authorized official:** MARTIE TESHAK (MANAGER)
- **Authorized official phone:** (563) 359-1601

## Contact information

- **Practice address:** 407 S 4TH ST, CLINTON, IA 52732-4512
- **Practice address phone:** (563) 243-4406
- **Practice address fax:** (563) 243-8534
- **Mailing address:** 407 S 4TH ST, CLINTON, IA 52732-4512
- **Mailing address phone:** (563) 243-4406
- **Mailing address fax:** (563) 243-8534

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 03/17/2006
- **Last updated:** 08/22/2020