Institute of Facial Surgery St Paul, Pllc

NPI #1477871457 in Maplewood, Minnesota

Provider Information

NPI Number: 1477871457
Entity Type: Organization
Organization Name: Institute of Facial Surgery St Paul, Pllc
Primary Specialty: Clinic/Center - Dental
Enumeration Date: May 14, 2010
Last Updated: Apr 21, 2011

Practice Location

Address: 1774 COPE AVE E
Address 2: SUITE 140
City: Maplewood
State: Minnesota
ZIP Code: 55109-2662
Phone: (651) 774-9611

Authorized Official

Name: DR. JERRY KENT BRUNSOMAN, D.D.S.
Title: PRESIDENT
Phone: (651) 774-9611

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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