Individual
SUDHEER J. SURPURE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, DDS
Contact information
Practice address
1600 W UNIVERSITY AVE STE 101, FLAGSTAFF, AZ 86001-3154
(928) 247-6200
(702) 472-8575
Mailing address
1600 W UNIVERSITY AVE STE 101, FLAGSTAFF, AZ 86001-3154
(928) 247-6200
(602) 957-3282
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
OMFS SPECIALTY 157
OK
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
OMS 89
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
41157
AZ
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
A92044
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A920440
—
CA
Enumeration date
10/31/2006
Last updated
10/13/2023
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