Organization
CENTRAL LAKES ORAL & FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODERICK DUANE VAN SURKSUM DDS (OWNER DENTIST)
(320) 257-9555
Entity
Organization
Contact information
Practice address
2380 TROOP DRIVE, STE 202, SARTELL, MN 56377
(320) 257-9555
(320) 257-9558
Mailing address
2380 TROOP DRIVE, STE 202, SARTELL, MN 56377
(320) 257-9555
(320) 257-9558
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8600574
MEDICA
—
01
—
A65221025048
PREFERRED
—
Enumeration date
11/06/2006
Last updated
08/22/2020
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