NPI | 1982371456 |
---|---|
Entity Type | Organization |
Authorized Contact | RODERICK VANSURKSUM Oral Surgeon/Owner 952-935-8420 |
Organization Subpart ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
Additional Taxonomies | 1223P0700X Dentist Prosthodontics |
1223S0112X Dentist Oral and Maxillofacial Surgery | |
Enumeration Date | 2021-08-24 |
Last Update Date | 2024-09-12 |