| NPI | 1689723686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY KENT BRUNSOMAN President 651-774-9611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2020-08-22 |