| NPI | 1386723575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODERICK DUANE VAN SURKSUM Owner Dentist 320-257-9555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-08-22 |