NPIMap

PDG, P.a.

Organization Active NPI Dental Clinic/Center · Plymouth, MN

NPI 1376984013 · NPPES record last updated Oct 28, 2020

Key facts

NPI
1376984013
Entity type
Organization (NPI type 2)
Primary specialty
Dental Clinic/Center 261QD0000X
Legal business name
PDG, P.A.
Practice address
4410 Nathan LN N
Plymouth, MN 55442-2586
Phone
(763) 233-3350
Fax
(763) 233-3352
NPI assigned
Jul 10, 2013
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.

National Provider Directory

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

Locations

4410 Nathan Ln N
Plymouth, MN 55442
Phone (763) 233-3350

Specialties & licenses

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

Addresses

Primary practice location

4410 Nathan LN N
Plymouth, MN 55442-2586

Mailing address

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

Other names

  • Park Dental 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": "1373414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1376984013",
    "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": "4410 NATHAN LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554422586",
            "telephone_number": "763-233-3350",
            "fax_number": "763-233-3352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDG, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-10",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Dental",
            "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.