NPIMap

Organization Active NPI

PDG, P.a.

Doing business as Park Dental

  • General Practice Dentistry
  • Maple Grove, MN
National Provider Identifier
1487712915
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PDG, P.A.
Doing business as
Park Dental
Practice address
9600 Upland LN N
Suite 200
Maple Grove, MN 55369-4461
Phone
(763) 416-0037
Fax
(763) 420-5428
NPI assigned
Dec 5, 2006
Last updated
Oct 28, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PDG, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

9600 Upland LN N
Suite 200
Maple Grove, MN 55369-4461

Mailing address

2200 County Road C W
Suite 2210
Roseville, MN 55113-2504
Phone (651) 633-0500

Other names 1

  • Park Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
PDG PA65 organizations share this tax ID, including this one
Part of
PDG PA

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.

View all 24

Locations

9600 Upland Ln N
Ste 200
Maple Grove, MN 55369
Phone (763) 416-0037

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1487712915",
    "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": "551132504",
            "telephone_number": "651-633-0500",
            "fax_number": "651-636-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 UPLAND LN N",
            "address_2": "SUITE 200",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694461",
            "telephone_number": "763-416-0037",
            "fax_number": "763-420-5428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDG, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PDG, P.A.",
        "enumeration_date": "2006-12-05",
        "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": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.