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Organization
PDG, PA
Active
Organization
PDG, PA
Active
Other names
Park Dental
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON HESSE (CREDENTIALING SPECIALIST)
(651) 746-2815
Entity
Organization
Contact information
Practice address
16991 198TH AVE NW, BIG LAKE, MN 55309
(763) 263-6350
(763) 263-0136
Mailing address
2200 COUNTY ROAD C W STE 2210, ROSEVILLE, MN 55113-2551
(651) 746-2815
(651) 209-6312
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/18/2017
Last updated
10/28/2020
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