Active NPI
PDG, PA
- Dental Clinic/Center
- Rochester, MN
National Provider Identifier
1396199832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Clinic/Center
- Legal business name
- PDG, PA
- Practice address
- 3780 Marketplace Dr NW Ste 112
Rochester, MN 55901-3225 - Phone
- (507) 288-1633
- Fax
- (507) 288-2716
- NPI assigned
- Apr 21, 2016
- Last updated
- Jul 21, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. John Gulon
- Title
- President
- Phone
- (651) 633-0500
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | Primary |
Addresses
Primary practice location
3780 Marketplace Dr NW Ste 112
Rochester, MN 55901-3225
Mailing address
2200 County Road C W
Ste 2210
Roseville, MN 55113-2550
Phone (651) 636-6350
National Provider Directory
National Provider Directory- Tax ID family
- Facial Pain Center Edin
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.
Locations
3780 Marketplace Dr NW
Ste 112
Rochester, MN 55901
Phone (507) 288-1633
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- General Practice Dentistry
- Rochester, MN
- NPI 1578488920
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461196800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1396199832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 COUNTY ROAD C W",
"address_2": "STE 2210",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551132550",
"telephone_number": "651-636-6350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3780 MARKETPLACE DR NW STE 112",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "559013225",
"telephone_number": "507-288-1633",
"fax_number": "507-288-2716"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PDG, PA",
"organizational_subpart": "NO",
"enumeration_date": "2016-04-21",
"last_updated": "2022-07-21",
"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."
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.