# SUDHEER J. SURPURE, MD, DDS, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1447857024
- **Authorized official:** DR. SUDHEER J. SURPURE MD, DDS (PRESIDENT)
- **Authorized official phone:** (615) 480-5534

## Contact information

- **Practice address:** GRAND CANYON ORAL AND FACIAL SURGERY, 1600 W. SUNSET ROAD, SUITE B, HENDERSON, NV 89014
- **Practice address phone:** (615) 480-5534
- **Mailing address:** 1620 E CASTLE HILLS DR, FLAGSTAFF, AZ 86005-2725
- **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:** 10/06/2020
- **Last updated:** 10/06/2020