PDG, PA (NPI# 1104201284) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104201284 |
| Entity Type | Organization |
| Organization Name | PDG, PA |
| Other Organization Name | FACIAL PAIN CENTER |
| Practice Address |
1835 County Road C W Suite 200 Roseville MN 55113 |
| Mailing Address |
2200 County Road C W Suite 2210 Roseville MN 55113-2550 |
| Practice Telephone | 6512097088 |
| Practice Fax Number | 6516361118 |
| Mailing Telephone | 6516330500 |
| Mailing Fax Number | 6516366350 |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2020-10-28 |
| Authorized Official Name | DR. JOHN GULON (PRESIDENT) |
| Authorized Official Telephone | 6516330500 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | Y |
| Parent Organization Name | PDG, P.A. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Facial Pain Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649838343 | Pdg, Pa | Clinic/Center | 7774 Hargis Pkwy Ste 106, Woodbury, MN 55129-2305 | 2019-05-29 |
| 1629589544 | Pdg, Pa | Clinic/Center | 16991 198th Ave Nw, Big Lake, MN 55309 | 2017-10-18 |
| 1861931545 | Pdg, Pa | Clinic/Center | 605 Hillcrest Ave Ste 210, Owatonna, MN 55060-3680 | 2017-02-15 |
| 1285170464 | Pdg, Pa | Clinic/Center | 18230 Zane St Nw, Elk River, MN 55330-4501 | 2017-01-12 |
| 1518403831 | Pdg, Pa | Clinic/Center | 324 W Superior St Ste 1130, Duluth, MN 55802-1714 | 2017-01-10 |
| 1396199832 | Pdg, Pa | Clinic/Center | 3780 Marketplace Dr Nw Ste 112, Rochester, MN 55901-3225 | 2016-04-21 |
| 1598128647 | Pdg, Pa | Clinic/Center | 14170 Highway 13 S, Savage, MN 55378-2587 | 2016-04-05 |
| 1144780420 | Pdg, Pa | Clinic/Center | 906 Woodland Ave, Duluth, MN 55812-1113 | 2019-03-22 |
| 1689122442 | Pdg, Pa | Clinic/Center | 7501 80th St S, #214, Cottage Grove, MN 55016-3020 | 2016-09-21 |
| 1346798600 | Pdg, Pa | Clinic/Center | 901 Marquette Ave Ste 230, Minneapolis, MN 55402-3260 | 2016-09-15 |
| Street Address |
1835 COUNTY ROAD C W SUITE 200 |
| City | ROSEVILLE |
| State | MN |
| Zip Code | 55113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588630925 | Derek Allen Moline | Optometrist | 1835 County Road C W, Suite 140, Roseville, MN 55113-1352 | 2006-02-26 |
| 1518493170 | North Memorial Health Care | Clinic/Center | 1835 County Road C W, #150, Roseville, MN 55113-1352 | 2017-05-02 |
| 1366899437 | Chloe Ferrar | Physician Assistant | 1835 County Road C W, Roseville, MN 55113-1352 | 2016-05-18 |
| 1598125064 | Lauren H Massopust | Physician Assistant | 1835 County Road C W, 150, Roseville, MN 55113-1352 | 2016-02-26 |
| 1811356397 | Jeremiah Lynch | Physician Assistant | 1835 County Road C W, Roseville, MN 55113-1352 | 2016-02-12 |
| 1477950475 | Kelsey L Holmes | Physician Assistant | 1835 County Road C W, 250, Roseville, MN 55113-1352 | 2014-11-20 |
| 1578822599 | Hunter Hendry Piermont | Student in an Organized Health Care Education/Training Program | 1835 County Road C W, Suite 220, Roseville, MN 55113-1352 | 2012-05-11 |
| 1801152814 | Amdahl Hearing, Inc. | Clinic/Center | 1835 County Road C W, Ste. 80, Roseville, MN 55113-1352 | 2012-04-03 |
| 1063782621 | Tareen Dermatology, P.a. | Non-Pharmacy Dispensing Site | 1835 County Road C W, 250, Roseville, MN 55113-1352 | 2012-01-12 |
| 1558659615 | Jason Michael Prostrollo | Pediatrics | 1835 County Road C W, Roseville, MN 55113-1352 | 2011-07-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396384376 | Zachary Mattson | Physician Assistant | Regus Coworking Space 2355 Highway 36 West, Suite 400, Office #427, Roseville, MN 55113 | 2019-12-23 |
| 1467010330 | Ahmed Issa | Student in an Organized Health Care Education/Training Program | 1550 Larpenteur Ave W, Apt 235, St Paul, MN 55113 | 2019-06-05 |
| 1821653833 | Suite Living Senior Care of Little Canada | Assisted Living Facility | 2740 Rice Street, Little Canada, MN 55113 | 2019-05-06 |
| 1902370505 | Diverse Assessments and Treatment, LLC | Psychologist | 1935 Cty Rd B2 W Ste 270, Roseville, MN 55113 | 2019-01-16 |
| 1588138473 | Applewood Home Health Care, LLC | Home Health | 2021 E Hennepin Avenue # 402-1, Minneapolis, MN 55113 | 2019-01-14 |
| 1699251520 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 2685 Patton Rd, Roseville, MN 55113 | 2018-07-13 |
| 1083104145 | Suite Living Senior Care of Roseville | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55113 | 2018-05-15 |
| 1477055796 | Sunrise Residential Services LLC | Home Health | 216 Maple Ln, Roseville, MN 55113 | 2018-03-02 |
| 1194223024 | Alissa Hoff | Specialist | 1595 Mn 36 - 584 10 Rosedale Center, Roseville, MN 55113 | 2018-01-25 |
| 1841705118 | Kingsland Care Services Incorporated | Case Management | 2301 Rice Street, Suite 101, Roseville, MN 55113 | 2017-12-08 |
| Find all providers in zip 55113 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053935916 | Michael J. Petersen, D.d.s., P.a. | Clinic/Center | 3101 Old Highway 8 Ste 303, Roseville, MN 55113-1076 | 2020-06-05 |
| 1346873288 | Van De Vyver Dental, P.C. | Clinic/Center | 25810 Kelly Rd Ste 2, Roseville, MI 48066-4467 | 2020-02-19 |
| 1518510643 | Ardalan Keshtkar Dds Inc | Clinic/Center | 10 Sierra Gate Plz Ste 130, Roseville, CA 95678-6646 | 2019-07-18 |
| 1659880805 | Gurkamal Sandhu Dds, Inc. | Clinic/Center | 1895 E Roseville Pkwy Ste 100, Roseville, CA 95661-7977 | 2017-09-20 |
| 1457875809 | Khs Pannu Dds Inc | Clinic/Center | 1950 Douglas Blvd Ste B1, Roseville, CA 95661-3827 | 2017-07-27 |
| 1801248950 | Baban Dhariwal Dds Pa Inc | Clinic/Center | 6049 Douglas Blvd Ste 9, Roseville, CA 95746-6249 | 2016-07-12 |
| 1972610046 | Donald E. Clarke, D.d.s., Inc. | Clinic/Center | 2200 Professional Dr, Suite 210, Roseville, CA 95661-7763 | 2006-08-24 |
| 1497352363 | David A. Susko, Dds | Clinic/Center | 20737 E 13 Mile Rd, Roseville, MI 48066-4503 | 2020-10-05 |
| 1396385175 | Bosch Dental Pllc | Clinic/Center | 2680 Snelling Ave N, Roseville, MN 55113-1876 | 2020-01-09 |
| 1790320265 | Richard B Knight Dds Ms Inc | Clinic/Center | 2520 Douglas Blvd Ste 130, Roseville, CA 95661-3993 | 2019-11-08 |
| Find all providers in ROSEVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.