| South Suburban Oral & Maxillofacial Surgeons Ltd | |
|
625 East Nicollet Boulevard Suite 205 Burnsville MN 55337-6735 | |
| (952) 435-0310 | |
| (952) 435-0311 |
| Full Name | South Suburban Oral & Maxillofacial Surgeons Ltd |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 625 East Nicollet Boulevard, Burnsville, Minnesota |
| Authorized Official Name and Position | Lawrence A Palmersheim (CEO) |
| Authorized Official Contact | 9524350310 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Suburban Oral & Maxillofacial Surgeons Ltd 625 East Nicollet Boulevard Suite 205 Burnsville MN 55337-6735 Ph: (952) 435-0310 | South Suburban Oral & Maxillofacial Surgeons Ltd 625 East Nicollet Boulevard Suite 205 Burnsville MN 55337-6735 Ph: (952) 435-0310 |
| NPI Number | 1134103674 |
|---|---|
| Provider Enumeration Date | 11/29/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134103674 | NPI | - | NPPES |
| 6B299PA | Other | MN | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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