Active NPI
PDG, PA
Doing business as Park Dental
- Dental Clinic/Center
- Big Lake, MN
National Provider Identifier
1629589544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Clinic/Center
- Legal business name
- PDG, PA
- Doing business as
- Park Dental
- Practice address
- 16991 198TH Ave NW
Big Lake, MN 55309 - Phone
- (763) 263-6350
- Fax
- (763) 263-0136
- NPI assigned
- Oct 18, 2017
- Last updated
- Oct 28, 2020
- 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
- Shannon Hesse
- Title
- Credentialing Specialist
- Phone
- (651) 746-2815
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | NU | Primary |
Addresses
Primary practice location
16991 198TH Ave NW
Big Lake, MN 55309
Mailing address
2200 County Road C W Ste 2210
Roseville, MN 55113-2551
Phone (651) 746-2815
Other names 1
- Park Dental
National Provider Directory
National Provider Directory- Tax ID family
- Pdgpa
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.
Practitioners & affiliated clinicians
Practitioners 6
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.
-
- Dentist
- Big Lake, MN
- NPI 1235797820
-
- General Practice Dentistry
- Big Lake, MN
- NPI 1902937782
-
- Dental Hygienist
- Big Lake, MN
- NPI 1518098300
-
- Dental Hygienist
- Big Lake, MN
- NPI 1538290325
-
- General Practice Dentistry
- Big Lake, MN
- NPI 1245075977
-
- Dental Hygienist
- Big Lake, MN
- NPI 1992836787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508284800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1603843200000",
"number": "1629589544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 COUNTY ROAD C W STE 2210",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551132551",
"telephone_number": "651-746-2815",
"fax_number": "651-209-6312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16991 198TH AVE NW",
"city": "BIG LAKE",
"state": "MN",
"postal_code": "55309",
"telephone_number": "763-263-6350",
"fax_number": "763-263-0136"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PDG, PA",
"organizational_subpart": "NO",
"enumeration_date": "2017-10-18",
"last_updated": "2020-10-28",
"certification_date": "2020-10-28",
"status": "A",
"authorized_official_last_name": "HESSE",
"authorized_official_first_name": "SHANNON",
"authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
"authorized_official_telephone_number": "651-746-2815"
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Park Dental",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Park Dental",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Big Lake, 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.