| 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 |