NPIMap

PDG, P.a

Organization Active NPI Dental Clinic/Center · Plymouth, MN

NPI 1366096513 · NPPES record last updated Oct 28, 2020

Key facts

NPI
1366096513
Entity type
Organization (NPI type 2)
Primary specialty
Dental Clinic/Center 261QD0000X
Legal business name
PDG, P.A
Practice address
1525 County Road 101 N
Plymouth, MN 55447-2707
Phone
(763) 475-2829
NPI assigned
Jul 26, 2019
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Casey Luke Newton (65 organizations share this tax ID)

Locations

1525 County Road 101 N
Plymouth, MN 55447
Phone (763) 475-2820

Specialties & licenses

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

Addresses

Primary practice location

1525 County Road 101 N
Plymouth, MN 55447-2707

Mailing address

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

Other names

  • Park Dental Plymouth Lakes Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 28, 2020.

{
    "created_epoch": "1564099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1366096513",
    "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": "1525 COUNTY ROAD 101 N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554472707",
            "telephone_number": "763-475-2829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDG, P.A",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-26",
        "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 SPECIALIST",
        "authorized_official_telephone_number": "651-746-2815"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Dental Plymouth Lakes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, MN

All providers in Plymouth, MN · Dental Clinic/Center in Minnesota

Sources for this page

Verify at the official NPI Registry.