NPIMap

PDG, PA

Organization Active NPI Dental Clinic/Center · Rochester, MN

NPI 1396199832 · NPPES record last updated Jul 21, 2022

Key facts

NPI
1396199832
Entity type
Organization (NPI type 2)
Primary specialty
Dental Clinic/Center 261QD0000X
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
Organization subpart
No

Authorized official

Name
Dr. John Gulon
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

3780 Marketplace Dr NW
Ste 112
Rochester, MN 55901
Phone (507) 258-7934

Specialties & licenses

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

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 21, 2022.

{
    "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

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Sources for this page

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