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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 J. SURPURE MD, DDS (PRESIDENT)
(615) 480-5534
Entity
Organization
Contact information
Practice address
GRAND CANYON ORAL AND FACIAL SURGERY, 1600 W. SUNSET ROAD, SUITE B, HENDERSON, NV 89014
(615) 480-5534
Mailing address
1620 E CASTLE HILLS DR, FLAGSTAFF, AZ 86005-2725
(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
10/06/2020
Last updated
10/06/2020
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