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Organization
INSTITUTE OF FACIAL SURGERY ST PAUL, PLLC
Active
Organization
INSTITUTE OF FACIAL SURGERY ST PAUL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY KENT BRUNSOMAN D.D.S. (PRESIDENT)
(651) 774-9611
Entity
Organization
Contact information
Practice address
1774 COPE AVE E, SUITE 140, MAPLEWOOD, MN 55109-2662
(651) 774-9611
(651) 748-3704
Mailing address
1774 COPE AVE E, SUITE 140, MAPLEWOOD, MN 55109-2662
(651) 774-9611
(651) 748-3704
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D6950
MN
Other
Enumeration date
05/14/2010
Last updated
04/21/2011
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