NPIMap

Organization Active NPI

PDG, P.a.

Doing business as Park Dental

  • Dental Clinic/Center
  • Coon Rapids, MN
National Provider Identifier
1285993345
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
3161 Northdale Blvd NW
Coon Rapids, MN 55433-1825
Phone
(763) 210-7096
NPI assigned
May 10, 2012
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 NU Primary

Addresses

Primary practice location

3161 Northdale Blvd NW
Coon Rapids, MN 55433-1825

Mailing address

2200 County Road C W
Suite 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 24

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

View all 24

Locations

3161 Northdale Blvd NW
Coon Rapids, MN 55433
Phone (651) 636-2016

Practitioners & affiliated clinicians

Practitioners 3

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": "1336608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1285993345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 COUNTY ROAD C W",
            "address_2": "SUITE 2210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132550",
            "telephone_number": "651-633-0500",
            "fax_number": "651-636-6894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3161 NORTHDALE BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554331825",
            "telephone_number": "763-210-7096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDG, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-10",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coon Rapids, 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.