Organization
PDG, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GULON (PRESIDENT)
(651) 633-0500
Entity
Organization
Contact information
Practice address
18230 ZANE ST NW, ELK RIVER, MN 55330-4501
(763) 201-1313
(763) 201-1314
Mailing address
2200 COUNTY ROAD C W, 2210, ROSEVILLE, MN 55113-2550
(651) 746-2815
(651) 209-6312
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/12/2017
Last updated
10/28/2020
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