Individual
RODERICK DUANE VANSURKSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11601 MINNETONKA MILLS RD STE F40, MINNETONKA, MN 55305-5189
(952) 935-8420
(952) 935-0147
Mailing address
11601 MINNETONKA MILLS RD STE F40, MINNETONKA, MN 55305-5189
(952) 935-8420
(952) 935-0147
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D11417
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
704432100
—
MN
Enumeration date
10/18/2007
Last updated
06/16/2021
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