| NPI | 1629606199 |
|---|---|
| Former Name | KELLY SURALIK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MN D14374) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D14374) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-01-28 |