# PRAIRIE ORAL SURGERY LTD

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

## Provider details

- **NPI number:** 1912859364
- **Authorized official:** ALYSSA AUCK CPC (FINANCIAL COORDINATOR)
- **Authorized official phone:** (701) 478-4404

## Contact information

- **Practice address:** 1225 WASHINGTON AVE, DETROIT LAKES, MN 56501-3905
- **Practice address phone:** (701) 478-4404
- **Practice address fax:** (701) 478-4407
- **Mailing address:** 2585 23RD AVE S UNIT A, FARGO, ND 58103-6172
- **Mailing address phone:** (701) 478-4404
- **Mailing address fax:** (701) 478-4407

## 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:** 02/10/2026
- **Last updated:** 02/10/2026