NPIMap

Organization Active NPI

PDG, P.a.

Doing business as Park Dental Hermantown

  • Dental Clinic/Center
  • Hermantown, MN
National Provider Identifier
1184288979
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 Hermantown
Practice address
4891 Miller Truck Hwy.
Suite 100
Hermantown, MN 55811
Phone
(218) 722-7770
Fax
(218) 740-3234
NPI assigned
Apr 26, 2019
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
Shannon Hesse
Title
Credentialing Specialists
Phone
(651) 746-2815

Specialties & licenses 1

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

Addresses

Primary practice location

4891 Miller Truck Hwy.
Suite 100
Hermantown, MN 55811

Mailing address

2200 County Road C W Ste 2210
Roseville, MN 55113-2551
Phone (651) 746-2815

Other names 1

  • Park Dental Hermantown 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 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1556236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1184288979",
    "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": "651-746-2815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4891 MILLER TRUCK HWY.",
            "address_2": "SUITE 100",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "55811",
            "telephone_number": "218-722-7770",
            "fax_number": "218-740-3234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDG, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-26",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "HESSE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALISTS",
        "authorized_official_telephone_number": "651-746-2815"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Dental Hermantown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hermantown, 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.