PDG,P.A. (NPI# 1215003371) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215003371 |
| Entity Type | Organization |
| Organization Name | PDG,P.A. |
| Other Organization Name | PARK DENTAL |
| Practice Address |
12904 Central Ave Ne Blaine MN 55434-4147 |
| Mailing Address |
2200 County Road C W Suite 2210 Roseville MN 55113-2504 |
| Practice Telephone | 7637551330 |
| Mailing Telephone | 6516330500 |
| Mailing Fax Number | 6516366350 |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-10-28 |
| Authorized Official Name | DR. JOHN GULON (PRESIDENT) |
| Authorized Official Telephone | 6516330500 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | Y |
| Parent Organization Name | PDG, P.A. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Park Dental | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932256344 | Pdg,p.a. | Dentist | 2200 County Road C W, Suite 2210, Roseville, MN 55113 | 2007-01-05 |
| 1417015009 | Pdg,p.a. | Dentist | 917 Grand Ave, Saint Paul, MN 55105-3043 | 2006-12-05 |
| 1730247180 | Pdg,p.a. | Dentist | 13059 Ridgedale Dr, Minnetonka, MN 55305-1807 | 2006-12-05 |
| 1518033695 | Pdg,p.a. | Dentist | 6437 Brooklyn Blvd, Brooklyn Center, MN 55429-2174 | 2006-11-28 |
| 1083762041 | Pdg,p.a. | Clinic/Center | 6545 France Ave S, Suite 366, Edina, MN 55435 | 2007-01-08 |
| 1689732133 | Pdg,p.a. | Dentist | 4670 Park Nicollet Ave Se, Suite 100, Prior Lake, MN 55372-3908 | 2006-12-05 |
| 1083772669 | Pdg,p.a. | Dentist | 6545 France Ave S, Suite 390, Edina, MN 55435-2131 | 2006-12-05 |
| 1730247321 | Pdg,p.a. | Dentist | 8559 Edinbrook Pkwy, Brooklyn Park, MN 55443-3747 | 2006-12-05 |
| 1184782542 | Pdg,p.a. | Dentist | 40 W Nicollet Blvd, Burnsville, MN 55337-4524 | 2006-12-05 |
| 1306912480 | Pdg,p.a. | Dentist | 4200 W Old Shakopee Rd, Suite 100, Bloomington, MN 55437-2976 | 2006-11-28 |
| Street Address |
12904 CENTRAL AVE NE |
| City | BLAINE |
| State | MN |
| Zip Code | 55434-4147 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902398944 | Orthodontic Specialists of Minnesota, P.l.l.c. | Dentist | 12904 Central Ave Ne, Blaine, MN 55434 | 2018-06-05 |
| 1578089207 | Andrea Berge | Dentist | 12904 Central Ave Ne, Blaine, MN 55434-4147 | 2017-08-15 |
| 1104273085 | Thien Quang Pham | Dentist | 12904 Central Ave Ne, Blaine, MN 55434-4147 | 2016-05-19 |
| 1003263377 | Allison Marie Mcmillen | Dentist | 12904 Central Ave Ne, Blaine, MN 55434-4147 | 2016-05-17 |
| 1013355593 | Jeffrey Mark Ruhlmann | Dentist | 12904 Central Ave Ne, Blaine, MN 55434-4147 | 2013-06-06 |
| 1376980755 | Shawn Mccarthy | Dentist | 12904 Central Ave Ne, Blaine, MN 55434-4147 | 2013-05-27 |
| 1477600807 | Peter Jon Thompson | Dentist | 12904 Central Ave Ne, Blaine, MN 55434-4147 | 2007-01-05 |
| 1083777411 | Anissa Jane Kozlowski | Dentist | 12904 Central Ave Ne, Blaine, MN 55434-4147 | 2006-12-18 |
| 1215090659 | Robb David Kozlowski | Dentist | 12904 Central Ave Ne, Blaine, MN 55434-4147 | 2006-12-18 |
| 1043379514 | Stephen Michael Sawyer | Dentist | 12904 Central Ave Ne, Blaine, MN 55434-4147 | 2006-12-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023628591 | Rahul Farmah | Optometrist | 680 Hwy 10 Ne, Blaine, MN 55434 | 2020-08-08 |
| 1033770714 | Enduring Home Health Care Corp | Home Health | 10812 Fillmore Street, Blaine, MN 55434 | 2019-06-24 |
| 1932762408 | Vital Agency LLC | In Home Supportive Care | 12864 Fillmore Street Ne, Blaine, MN 55434 | 2019-04-19 |
| 1548751654 | Dustin Adam Kakach | Pharmacist | 600 County Hwy 10, Blaine, MN 55434 | 2018-05-24 |
| 1598253445 | Jacob James Apland | Behavioral Analyst | 12401 Oak Park Blvd Ne Apt 316, Blaine, MN 55434 | 2018-04-26 |
| 1962921924 | Mw Minnetonka Operating LLC | Assisted Living Facility | 1005 Paul Parkway Ne, Blaine, MN 55434 | 2017-09-11 |
| 1922526961 | Blaine Asc, LLC | Clinic/Center | 11225 Ulysses Street Northeast, Blaine, MN 55434 | 2017-08-30 |
| 1629591334 | Minnehaha Transportation Inc | Non-emergency Medical Transport (VAN) | 2507 Walnut St, Roseville, MN 55434 | 2017-07-25 |
| 1629590872 | Alexandra Staum Reif | Pediatrics | 11107 Ulysses Street Ne, Suite 100, Blaine, MN 55434 | 2017-07-10 |
| 1962939546 | Nicolette Gengel | Dentist | 1384 109th Ave Ne Ste 200, Blaine, MN 55434 | 2017-05-15 |
| Find all providers in zip 55434 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396398160 | Taylor Johnson | Dentist | 10155 University Ave Ne Ste 112, Blaine, MN 55434-8058 | 2019-07-22 |
| 1962939546 | Nicolette Gengel | Dentist | 1384 109th Ave Ne Ste 200, Blaine, MN 55434 | 2017-05-15 |
| 1982007803 | Blaine Dentistry, PC | Dentist | 1384 109th Ave Ne, Suite 200, Blaine, MN 55434-4515 | 2014-10-06 |
| 1063725109 | Melstrom Dental Pllc | Dentist | 11949 Central Ave Ne, Blaine, MN 55434-3911 | 2010-07-19 |
| 1861703639 | Choong Hyun Lee | Dentist | 341 C Street, Blaine, WA 98230 | 2010-06-28 |
| 1982930525 | John Charles Hitzemann | Dentist | 11354 Wildwood Ct Ne, Blaine, MN 55449-5901 | 2009-11-01 |
| 1477763092 | Donald Lyle Rathe | Dentist | 341 C . St., Blaine, WA 98230 | 2007-05-23 |
| 1154546877 | Carlos Ernesto Campodonico | Dentist | 11806 Aberdeen St Ne Ste 150, Blaine, MN 55449-4748 | 2007-04-16 |
| 1093842841 | Peixin Liu Dds | Dentist | 2407 109th Avenue, Suite 240, Blaine, MN 55449 | 2007-02-28 |
| 1134266869 | John Harold Troselius | Dentist | 9120 Baltimore St Ne, Blaine, MN 55449-4337 | 2007-01-31 |
| Find all providers in BLAINE | ||||
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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.