Organization
PDG, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN GULON (PRESIDENT)
(651) 633-0500
Entity
Organization
Contact information
Practice address
7501 80TH ST S, #214, COTTAGE GROVE, MN 55016-3020
(651) 459-2300
(651) 458-1836
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
D8289
MN
Other
Enumeration date
09/21/2016
Last updated
10/28/2020
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