Sudheer J Surpure MD DDS Inc

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

SUDHEER J SURPURE MD DDS INC

Practice address

1600 W University Ave Ste 101
Flagstaff, AZ 86001-3154

Phone

(928) 247-6200

NPI assigned

Feb 2, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sudheer Surpure, MD, DDSNPI 1235216185

Title

President

Phone

(615) 480-5534

Specialties & licenses 1

Addresses

Other names 1

• Grand Canyon Oral and Facial Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Tax ID family

Grand Canyon Oral and Facial Surgery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Sudheer J. Surpure, MD, DDS, Inc.

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Henderson, NV
  • NPI 1447857024
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sudheer J. Surpure, MD, DDS

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Flagstaff, AZ
  • NPI 1235216185
  Medicare reassignment NPD Authorized official
• Troy M Lam, D.D.S., M.D.

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Glendale, AZ
  • NPI 1851706048
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617840000000",
    "number": "1023609062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W SUNSET RD STE B",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890142655",
            "telephone_number": "615-480-5534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W UNIVERSITY AVE STE 101",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013154",
            "telephone_number": "928-247-6200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 W University Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "860013154",
            "country_code": "US",
            "telephone_number": "928-247-6200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 W Sunset Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890142655",
            "country_code": "US",
            "telephone_number": "615-480-5534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUDHEER J SURPURE MD DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-02",
        "last_updated": "2021-04-08",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "SURPURE",
        "authorized_official_first_name": "SUDHEER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-480-5534",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Canyon Oral and Facial Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grand Canyon Oral and Facial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Linda Stump
• James Patrick Stumpff, RPH
• John Anthony Stupinski, MD
• Ruth Su, PHARMD
• Allan Such, PA
• Birgit Suess, M.S., CCC-SLP
• Cassandra L Summer, PHARMD
• Fred Summerfelt, RDH AP
• Summit Chiropractic & Rehabilitation Inc
• Summit Chiropractic and Wellness Center PC

• Oral & Maxillofacial Surgery (D.M.D.) in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.