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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