1. Home
  2. Directory
  3. Arizona
  4. Flagstaff
  5. Oral Maxillofacial Surgery
  6. NPI Profile

GRAND CANYON ORAL AND FACIAL SURGERY
NPI 1023609062
Oral & Maxillofacial Surgery in Flagstaff, AZ

Active since February 02, 2021
1600 W UNIVERSITY AVE STE 101, FLAGSTAFF, AZ 86001(928) 247-6200 Get Directions Write a Review

NPPES record last updated: April 8, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Apr 8, 2021, Feb 2, 2021 (2 updates tracked since 2021).

About Grand Canyon Oral And Facial Surgery NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRAND CANYON ORAL AND FACIAL SURGERY (NPI 1023609062) is a healthcare organization registered as an oral & maxillofacial surgery in Flagstaff, Arizona and active in the NPI registry since February 2021. The organization maintains 2 additional practice locations and lists Sudheer Surpure, President, as its authorized official.

NPPES Registry Identity

NPI1023609062
Entity TypeOrganization
Primary Taxonomy204E00000X
Legal Business NameSUDHEER J SURPURE MD DDS INC
Location Address1600 W UNIVERSITY AVE STE 101Flagstaff, AZ 86001-3154
Mailing Address1600 W Sunset Rd Ste BHenderson, NV 89014-2655 · (615) 480-5534
Phone(928) 247-6200
Organization SubpartNo
Authorized OfficialSudheer SurpurePresident · (615) 480-5534
Enumeration DateFebruary 2, 2021
Last NPPES UpdateApril 8, 20212 updates tracked since enumeration
NPPES CertifiedMarch 16, 2021
✔ NPI 1023609062 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOral & Maxillofacial SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code204E00000X
Definition
Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.
1600 W UNIVERSITY AVE STE 101, Flagstaff, AZ 86001
Open in Google Maps ↗

Other Names 1

Doing Business AsGrand Canyon Oral And Facial Surgery

Secondary Practice Locations 2

Location 11600 W University Ave Ste 101Flagstaff, AZ 86001-3154 · Phone (928) 247-6200
Location 21600 W Sunset Rd Ste BHenderson, NV 89014-2655 · Phone (615) 480-5534

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Grand Canyon Oral And Facial Surgery is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Grand Canyon Oral And Facial Surgery, which bills Medicare for the services this clinician delivers.

Clinician (1)

Sudheer Surpure, MD, DDS
Maxillofacial Surgery
NPI 1235216185
1600 W UNIVERSITY AVE STE 101
Flagstaff, AZ 86001
(928) 247-6200
✔ PECOS✔ Accepts Medicare0.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sudheer J Surpure MD Dds Inc's NPI number?

The NPI number for Sudheer J Surpure MD Dds Inc is 1023609062. It was assigned to this organization in the NPPES registry on February 2, 2021. The provider is doing business as Grand Canyon Oral And Facial Surgery.

Where is Sudheer J Surpure MD Dds Inc located?

Sudheer J Surpure MD Dds Inc is located at 1600 W University Ave Ste 101, Flagstaff, AZ 86001. The listed phone number is (928) 247-6200.

What is Sudheer J Surpure MD Dds Inc's specialty?

The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

Is Sudheer J Surpure MD Dds Inc enrolled in Medicare?

Yes. Sudheer J Surpure MD Dds Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Sudheer J Surpure MD Dds Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Maxillofacial Surgery) reassigns their Medicare billing to Sudheer J Surpure MD Dds Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Sudheer J Surpure MD Dds Inc accept?

Health plans from Ambetter Health and Ambetter from Arizona Complete Health list Sudheer J Surpure MD Dds Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sudheer J Surpure MD Dds Inc was last updated on April 8, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.