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General NPI Number Information
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NPI Number | 1306912480
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Entity Type | Organization
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Legal Business Name | PDG,P.A.
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 4200 W OLD SHAKOPEE RD SUITE 100
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City | BLOOMINGTON
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State | MN
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Zip | 55437-2976
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Country | US
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Telephone | 952-831-6126
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 COUNTY ROAD C W SUITE 2210
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City | ROSEVILLE
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State | MN
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Zip | 55113-2504
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Country | US
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Telephone | 651-633-0500
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Fax | 651-636-6350
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN GULON
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Credential | D.D.S.
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Telephone | 651-633-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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