Organization
PDG, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN GULON DDS (PRESIDENT)
(651) 633-0500
Entity
Organization
Contact information
Practice address
11091 JASON AVE NE, SUITE 3, ALBERTVILLE, MN 55301-4699
(763) 497-2822
(763) 497-2955
Mailing address
2200 COUNTY ROAD C W, SUITE 2210, ROSEVILLE, MN 55113-2550
(651) 633-0500
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/15/2015
Last updated
10/28/2020
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