NPIMap

Organization Active NPI

PDG,P.a.

Doing business as Park Dental Edinborough way

  • General Practice Dentistry
  • Edina, MN
National Provider Identifier
1043807571
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PDG,P.A.
Doing business as
Park Dental Edinborough way
Practice address
3300 Edinborough Way Ste 210
Edina, MN 55435-5958
Phone
(952) 831-1112
NPI assigned
Dec 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Authorized official

Name
Shannon Hesse
Title
Credentialing Specialist
Phone
(651) 746-2815

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3300 Edinborough Way Ste 210
Edina, MN 55435-5958

Mailing address

2200 County Road C W Ste 2210
Roseville, MN 55113-2551
Phone (651) 633-0500

Other names 1

  • Park Dental Edinborough way Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Casey Luke Newton65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

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

View all 13

Locations

3300 Edinborough Way
Ste 210
Edina, MN 55435
Phone (952) 831-1112

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1609286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609286400000",
    "number": "1043807571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 COUNTY ROAD C W STE 2210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132551",
            "telephone_number": "651-633-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 EDINBOROUGH WAY STE 210",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355958",
            "telephone_number": "952-831-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDG,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-30",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "HESSE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "651-746-2815"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Dental Edinborough way",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.