# CENTRAL LAKES ORAL & FACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386723575
- **Authorized official:** DR. RODERICK DUANE VAN SURKSUM DDS (OWNER DENTIST)
- **Authorized official phone:** (320) 257-9555

## Contact information

- **Practice address:** 2380 TROOP DRIVE, STE 202, SARTELL, MN 56377
- **Practice address phone:** (320) 257-9555
- **Practice address fax:** (320) 257-9558
- **Mailing address:** 2380 TROOP DRIVE, STE 202, SARTELL, MN 56377
- **Mailing address phone:** (320) 257-9555
- **Mailing address fax:** (320) 257-9558

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 11/06/2006
- **Last updated:** 08/22/2020