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
4155 DEAN LAKES BLVD, SHAKOPEE, MN 55379
(952) 303-8320
(952) 303-8325
Mailing address
2200 COUNTY ROAD C W STE 2210, ROSEVILLE, MN 55113-2551
(651) 636-6350
(651) 209-6312
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/07/2016
Last updated
10/28/2020
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