Active NPI
PDG, PA
- Dental Clinic/Center
- Shakopee, MN
National Provider Identifier
1821545930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Clinic/Center
- Legal business name
- PDG, PA
- Practice address
- 4155 Dean Lakes Blvd
Shakopee, MN 55379 - Phone
- (952) 303-8320
- Fax
- (952) 303-8325
- NPI assigned
- Sep 7, 2016
- 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
- Title
- President
- Phone
- (651) 633-0500
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | NU | Primary |
Addresses
Primary practice location
4155 Dean Lakes Blvd
Shakopee, MN 55379
Mailing address
2200 County Road C W Ste 2210
Roseville, MN 55113-2551
Phone (651) 636-6350
National Provider Directory
National Provider Directory- Tax ID family
- Pdgpa
Organizations with this tax ID in the same state 21
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Locations
4155 Dean Lakes Blvd
Shakopee, MN 55379
Phone (952) 303-8320
Practitioners & affiliated clinicians
Practitioners 2
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
- Shakopee, MN
- NPI 1861802910
-
- General Practice Dentistry
- Shakopee, MN
- NPI 1134737802
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473206400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1603843200000",
"number": "1821545930",
"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": "651-636-6350",
"fax_number": "651-209-6312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4155 DEAN LAKES BLVD",
"city": "SHAKOPEE",
"state": "MN",
"postal_code": "55379",
"telephone_number": "952-303-8320",
"fax_number": "952-303-8325"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PDG, PA",
"organizational_subpart": "NO",
"enumeration_date": "2016-09-07",
"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."
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shakopee, 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.