Organization
PDG, PA
Active
Other names
Park Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN GULON (PRESIDENT)
(651) 633-0500
Entity
Organization
Contact information
Practice address
15535 34TH AVE N, SUITE 250, PLYMOUTH, MN 55447-1481
(763) 233-3310
(763) 233-3312
Mailing address
2200 COUNTY ROAD C W, SUITE 2210, ROSEVILLE, MN 55113-2550
(651) 633-0500
(651) 636-6350
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/19/2014
Last updated
10/28/2020
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