Provider Demographics
NPI:1124122734
Name:SPRINGFIELD ASSOCIATES IN ORAL & MAXILLOFACIAL SURGERY LTD
Entity type:Organization
Organization Name:SPRINGFIELD ASSOCIATES IN ORAL & MAXILLOFACIAL SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:NEWTON
Authorized Official - Last Name:WHEAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-546-8100
Mailing Address - Street 1:3007 SPRING MILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6558
Mailing Address - Country:US
Mailing Address - Phone:217-546-8100
Mailing Address - Fax:
Practice Address - Street 1:3007 SPRING MILL DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6558
Practice Address - Country:US
Practice Address - Phone:217-546-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID
IL787281Medicare PIN
T39108Medicare UPIN
IL379010Medicare PIN