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NPI Code Detail

MEDICARE: PDG, P.A.

MEDICARE: PDG, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1841366093
Entity Type Code : Organization
Provider Name (Legal Business Name) : PDG, P.A.
Provider Business Mailing Address
First Line : 3030 CENTRE POINTE DR
Second Line : SUITE 100
City : ROSEVILLE
State : MN
Zip : 55113-1112
Country : US
Telephone Number : 651-286-8100
Fax Number : 651-633-6811
Provider Business Practice Location Address
First Line : 14990 GLAZIER AVE
Second Line : SUITE 100
City : APPLE VALLEY
State : MN
Zip : 55124-7818
Country : US
Telephone Number : 952-431-5114
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOHN GULON
Credential : D.D.S
Telephone Number : 952-949-2536
Provider Enumeration Date : 11/28/2006
Last Update Date : 10/28/2020

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Directions to “PDG, P.A. ” Practice Location

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