# SOUTH SUBURBAN ORAL & MAXILLOFACIAL SURGEONS LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134103674
- **Authorized official:** DR. LAWRENCE A PALMERSHEIM DDS (CEO)
- **Authorized official phone:** (952) 435-0310

## Contact information

- **Practice address:** 625 EAST NICOLLET BOULEVARD, SUITE 205, BURNSVILLE, MN 55337-6735
- **Practice address phone:** (952) 435-0310
- **Practice address fax:** (952) 435-0311
- **Mailing address:** 625 EAST NICOLLET BOULEVARD, SUITE 205, BURNSVILLE, MN 55337-6735
- **Mailing address phone:** (952) 435-0310
- **Mailing address fax:** (952) 435-0311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 11/29/2005
- **Last updated:** 08/22/2020