Organization
PDG, P.A.
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
11240 STILLWATER BLVD N, LAKE ELMO, MN 55042-9321
(651) 777-0210
(651) 777-0320
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
11/15/2013
Last updated
10/28/2020
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