Individual
DUANE MATHEW SUSHOREBA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
20 5TH ST SE, COOK, MN 55723-9702
(218) 666-5958
(218) 666-5099
Mailing address
20 5TH ST SE, DENTAL, COOK, MN 55723-9702
(218) 666-5958
(218) 666-5099
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8861
MN
Other
Enumeration date
02/17/2006
Last updated
07/08/2007
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