Active NPI
PDG,P.a.
Doing business as Park Dental
- General Practice Dentistry
- Prior Lake, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Legal business name
- PDG,P.A.
- Doing business as
- Park Dental
- Practice address
- 4670 Park Nicollet Ave SE
Suite 100
Prior Lake, MN 55372-3908 - Phone
- (952) 447-7606
- NPI assigned
- Dec 5, 2006
- 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
- Dr. John Gulon, D.D.S.
- Title
- President
- Phone
- (952) 949-2536
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | NU | Primary |
Addresses
Primary practice location
4670 Park Nicollet Ave SE
Suite 100
Prior Lake, MN 55372-3908
Mailing address
3030 Centre Pointe Dr
Suite 100
Roseville, MN 55113-1112
Phone (651) 286-8100
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.
Locations
4670 Park Nicollet Ave SE
Ste 100
Prior Lake, MN 55372
Phone (952) 447-7606
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
- Eden Prairie, MN
- NPI 1437218088
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": "1689732133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3030 CENTRE POINTE DR",
"address_2": "SUITE 100",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551131112",
"telephone_number": "651-286-8100",
"fax_number": "651-633-6811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4670 PARK NICOLLET AVE SE",
"address_2": "SUITE 100",
"city": "PRIOR LAKE",
"state": "MN",
"postal_code": "553723908",
"telephone_number": "952-447-7606"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PDG,P.A.",
"organizational_subpart": "NO",
"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": "952-949-2536",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.D.S."
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Park Dental",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Prior 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.