Central Lakes Oral & Facial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

CENTRAL LAKES ORAL & FACIAL SURGERY

Practice address

2380 Troop Drive
Ste 202
Sartell, MN 56377

Phone

(320) 257-9555

Fax

(320) 257-9558

NPI assigned

Nov 6, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Roderick Duane Van Surksum, DDS

Title

Owner Dentist

Phone

(320) 257-9555

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenneth Leroy Anderson III, D.D.S.

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Spring Hill, FL
  • NPI 1023230539

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386723575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2380 TROOP DRIVE",
            "address_2": "STE 202",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "56377",
            "telephone_number": "320-257-9555",
            "fax_number": "320-257-9558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2380 TROOP DRIVE",
            "address_2": "STE 202",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "56377",
            "telephone_number": "320-257-9555",
            "fax_number": "320-257-9558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL LAKES ORAL & FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VAN SURKSUM",
        "authorized_official_first_name": "RODERICK",
        "authorized_official_middle_name": "DUANE",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "320-257-9555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED",
            "identifier": "A65221025048",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "8600574",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Center for Pain Management, P.a.
• Centracare Clinic (CentraCare - Sartell Clinic)
• Centracare Clinic (CentraCare - Urology Clinic)
• Centracare Clinic (CentraCare Eye Center)
• Centracare Clinic (Central Minnesota Child Advocacy Center (CAC))
• Central Minnesota Endodontics, PA
• Central Minnesota Retina Consultants, PLLC (Central Minnesota Retina Specialists)
• Central Minnesota Surgeons LTD
• Central Minnesota Surgical Center, LLC
• Changing Pathways LLC

• Oral and Maxillofacial Surgery (Dentist) in Sartell, MN
• Providers in Sartell, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.