Active NPI
PDG,P.a.
Doing business as Park Dental
- General Practice Dentistry
- Coon Rapids, MN
National Provider Identifier
1821164963
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
- 9145 Springbrook Dr NW
Suite 100
Coon Rapids, MN 55433-5885 - Phone
- (763) 786-4632
- Fax
- (763) 786-8673
- NPI assigned
- Nov 28, 2006
- Organization subpart
- Yes
- Parent organization
- PDG, P.A.
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
- (651) 633-0500
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | Primary |
Addresses
Primary practice location
9145 Springbrook Dr NW
Suite 100
Coon Rapids, MN 55433-5885
Mailing address
2200 County Road C W
Suite 2210
Roseville, MN 55113-2504
Phone (651) 633-0500
Other names 1
- Park Dental
National Provider Directory
National Provider Directory- Tax ID family
- Pdgpa
- Part of
- Pdgpa
Organizations with this tax ID in the same state 23
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
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
- Coon Rapids, MN
- NPI 1154828242
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1603843200000",
"number": "1821164963",
"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": "9145 SPRINGBROOK DR NW",
"address_2": "SUITE 100",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554335885",
"telephone_number": "763-786-4632",
"fax_number": "763-786-8673"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PDG,P.A.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PDG, P.A.",
"enumeration_date": "2006-11-28",
"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 Coon Rapids, 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.