NPIMap

PDG, PA

Organization Active NPI Dental Clinic/Center · Albertville, MN

NPI 1366826752 · NPPES record last updated Oct 28, 2020

Key facts

NPI
1366826752
Entity type
Organization (NPI type 2)
Primary specialty
Dental Clinic/Center 261QD0000X
Legal business name
PDG, PA
Practice address
11091 Jason Ave NE
Suite 3
Albertville, MN 55301-4699
Phone
(763) 497-2822
Fax
(763) 497-2955
NPI assigned
Jul 15, 2015
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 24

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

Practitioners 1

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

National Provider Directory

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

Locations

11091 Jason Ave NE
Ste 3
Albertville, MN 55301
Phone (763) 497-2822

Specialties & licenses

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

Addresses

Primary practice location

11091 Jason Ave NE
Suite 3
Albertville, MN 55301-4699

Mailing address

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

Other providers in Albertville, MN

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

Sources for this page

Verify at the official NPI Registry.