NPIMap

Organization Active NPI

PDG, P.a.

Doing business as Park Dental

  • Dental Clinic/Center
  • Minneapolis, MN
National Provider Identifier
1023309549
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PDG, P.A.
Doing business as
Park Dental
Practice address
2600 39TH Ave NE
225
Minneapolis, MN 55421-4379
Phone
(763) 781-7475
Fax
(763) 781-0828
NPI assigned
May 2, 2011
Last updated
Oct 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John Gulon, DDS
Title
President
Phone
(651) 633-0500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

2600 39TH Ave NE
225
Minneapolis, MN 55421-4379

Mailing address

2200 County Road C W
2210
Roseville, MN 55113-2550
Phone (651) 633-0500

Other names 1

  • Park Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pdgpa65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

2600 39th Ave NE
Ste 225
Saint Anthony, MN 55421
Phone (763) 781-7475

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1023309549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 COUNTY ROAD C W",
            "address_2": "2210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132550",
            "telephone_number": "651-633-0500",
            "fax_number": "651-636-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 39TH AVE NE",
            "address_2": "225",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554214379",
            "telephone_number": "763-781-7475",
            "fax_number": "763-781-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDG, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-02",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "GULON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-633-0500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.