# INSTITUTE OF FACIAL SURGERY ST PAUL

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1689723686
- **Authorized official:** DR. JERRY KENT BRUNSOMAN D.D.S., M.S. (PRESIDENT)
- **Authorized official phone:** (651) 774-9611

## Contact information

- **Practice address:** 1774 COPE AVE E, SUITE 140, MAPLEWOOD, MN 55109-2662
- **Practice address phone:** (651) 774-9611
- **Practice address fax:** (651) 748-3704
- **Mailing address:** 1774 COPE AVE E, SUITE 140, MAPLEWOOD, MN 55109-2662
- **Mailing address phone:** (651) 774-9611
- **Mailing address fax:** (651) 748-3704

## 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:** 01/09/2007
- **Last updated:** 08/22/2020