# SUDHEER J SURPURE MD DDS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Grand Canyon Oral and Facial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023609062
- **Authorized official:** DR. SUDHEER SURPURE MD, DDS (PRESIDENT)
- **Authorized official phone:** (615) 480-5534

## Contact information

- **Practice address:** 1600 W UNIVERSITY AVE STE 101, FLAGSTAFF, AZ 86001-3154
- **Practice address phone:** (928) 247-6200
- **Mailing address:** 1600 W SUNSET RD STE B, HENDERSON, NV 89014-2655
- **Mailing address phone:** (615) 480-5534

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 02/02/2021
- **Last updated:** 04/08/2021