Organization
PDG,P.A.
Active
Other names
Park Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN GULON D.D.S. (PRESIDENT)
(952) 949-2536
Entity
Organization
Contact information
Practice address
4670 PARK NICOLLET AVE SE, SUITE 100, PRIOR LAKE, MN 55372-3908
(952) 447-7606
Mailing address
3030 CENTRE POINTE DR, SUITE 100, ROSEVILLE, MN 55113-1112
(651) 286-8100
(651) 633-6811
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/05/2006
Last updated
10/28/2020
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