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Organization
SUDHEER J SURPURE MD DDS INC
Active
Organization
SUDHEER J SURPURE MD DDS INC
Active
Other names
Grand Canyon Oral and Facial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUDHEER SURPURE MD, DDS (PRESIDENT)
(615) 480-5534
Entity
Organization
Contact information
Practice address
1600 W UNIVERSITY AVE STE 101, FLAGSTAFF, AZ 86001-3154
(928) 247-6200
Mailing address
1600 W SUNSET RD STE B, HENDERSON, NV 89014-2655
(615) 480-5534
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
02/02/2021
Last updated
04/08/2021
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