PDG, PA (NPI# 1396120473) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396120473 |
| Entity Type | Organization |
| Organization Name | PDG, PA |
| Other Organization Name | FACIAL PAIN CENTER |
| Practice Address |
8650 Hudson Blvd N Suite 105 Lake Elmo MN 55042 |
| Mailing Address |
2200 County Road C W Suite 2210 Roseville MN 55113-2550 |
| Practice Telephone | 6513790564 |
| Practice Fax Number | 6515011471 |
| 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 |
8650 HUDSON BLVD N SUITE 105 |
| City | LAKE ELMO |
| State | MN |
| Zip Code | 55042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902805278 | East Metro Asc LLC | Clinic/Center | 8650 Hudson Blvd N, Lake Elmo, MN 55042-8448 | 2005-07-19 |
| 1932587383 | Infinite Health Collaborative, Pa | Durable Medical Equipment & Medical Supplies | 8650 Hudson Blvd N, Suite 100, Lake Elmo, MN 55042-9747 | 2015-05-18 |
| 1003212176 | Michelle Cunningham | Nurse Anesthetist, Certified Registered | 8650 Hudson Blvd N, Suite 235, Lake Elmo, MN 55042-9747 | 2014-11-17 |
| 1558648337 | St. Croix Orthopaedics, P.a. | Durable Medical Equipment & Medical Supplies | 8650 Hudson Blvd N, Ste. 100, Lake Elmo, MN 55042-9747 | 2011-11-08 |
| 1497072680 | Patricia Akers | Nurse Anesthetist, Certified Registered | 8650 Hudson Blvd N, Suite 235, Lake Elmo, MN 55042-9747 | 2010-04-27 |
| 1457593550 | Pediatric and Young Adult Medicine, Pa | Clinic/Center | 8650 Hudson Blvd N, Suite 125, Lake Elmo, MN 55042-9747 | 2009-04-03 |
| 1326178948 | Lakeview Hospital Inc. | Pharmacy | 8650 Hudson Blvd N, Suite 100, Lake Elmo, MN 55042-9747 | 2007-03-06 |
| 1982763454 | Alfredo Montes Imeri | Dentist | 8650 Hudson Blvd N, #105, Lake Elmo, MN 55042-9747 | 2006-12-08 |
| 1407915432 | John Clayton Withrow | Dentist | 8650 Hudson Blvd N, Suite105, Lake Elmo, MN 55042-9747 | 2006-12-06 |
| 1598824583 | Bruce Douglas Campbell | Dentist | 8650 Hudson Blvd N, Suite 105, Lake Elmo, MN 55042-9747 | 2006-12-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811440738 | Eleni Voltidi | Dentist | 8650 Hudson Blvd N Ste 105, Lake Elmo, MN 55042 | 2016-07-27 |
| 1760781314 | Swedehill Lifecare, LLC | Home Health | 8951 Highway 5, Lake Elmo, MN 55042 | 2011-03-22 |
| 1295859676 | St Croix Valley Dental Pllc | Dentist | 10035 City Walk Dr, Ste A Lake Elmo Dental, Lake Elmo, MN 55042 | 2007-03-19 |
| 1245281823 | Kent Gregory Brockmann | Psychiatry & Neurology | 8673 Eagle Point Blvd, Lake Elmo, MN 55042 | 2006-05-16 |
| 1396722674 | Nancy L Johnson-rauen | Physical Therapist | 9242 Hudson Blvd N Ste 400, Lake Elmo, MN 55042 | 2005-12-28 |
| 1639655384 | Katlyn Arndt | Psychiatry & Neurology | 8515 Eagle Point Blvd, Lake Elmo, MN 55042 | 2018-07-16 |
| 1295227247 | Orthodontic Specialists of Minnesota, P.l.l.c. | Dentist | 8650 Hudson Blvd N Ste 105, Lake Elmo, MN 55042 | 2018-06-05 |
| 1124455324 | Leslie Markowitz | Psychologist | 8550 Hudson Blvd N, Lake Elmo, MN 55042 | 2013-10-02 |
| 1215295001 | Jessica R Baltz | Marriage & Family Therapist | 3819 Laverne Ave N, Lake Elmo, MN 55042 | 2012-04-30 |
| 1790053460 | Jennifer Jean Solin | Psychologist | 8550 Hudson Blvd N, Lake Elmo, MN 55042 | 2011-12-08 |
| Find all providers in zip 55042 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154989507 | Red Oak Family Dental | Clinic/Center | 9939 Hudson Blvd N # 107, Lake Elmo, MN 55042-4109 | 2019-05-31 |
| 1639509334 | Pdg, P.a. | Clinic/Center | 11240 Stillwater Blvd N, Lake Elmo, MN 55042-9321 | 2013-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033710025 | Theresa M. Snell | Clinic/Center | 580 5th Ave Nw Ste 100, New Brighton, MN 55112-2836 | 2020-11-05 |
| 1376143248 | James M. Williams, D.d.s., P.a. | Clinic/Center | 620 Union St S, Mora, MN 55051-1818 | 2020-10-29 |
| 1235746058 | Asp Dental, PC | Clinic/Center | 17705 Hutchins Dr Ste 201, Minnetonka, MN 55345-4103 | 2020-09-25 |
| 1952918781 | Asp Dental, PC | Clinic/Center | 9800 Shelard Pkwy Ste 130, Plymouth, MN 55441-6451 | 2020-09-25 |
| 1518574532 | Stillwater Family Dental | Clinic/Center | 13481 60th St N Ste 100, Oak Park Heights, MN 55082-1089 | 2020-09-24 |
| 1093321531 | Barnett Dental Inc | Clinic/Center | 7962 Sunwood Dr Nw Ste 200, Ramsey, MN 55303-5172 | 2020-09-21 |
| 1356955868 | Todd A Brewer Dds Pllc | Clinic/Center | 603 Jefferson Ave Sw, Watertown, MN 55388 | 2020-09-02 |
| 1770195158 | Mark T. Sherman Dds Pa | Clinic/Center | 31011 Rasmussen Rd, Pequot Lakes, MN 56472-1227 | 2020-08-18 |
| 1689286015 | Lifelong Dental Care | Clinic/Center | 1525 Livingston Ave Ste B, West St Paul, MN 55118-3430 | 2020-08-18 |
| 1528678497 | Custom Smiles Dentistry, Pllc | Clinic/Center | 2258 Bunker Lake Blvd Nw, Andover, MN 55304-3900 | 2020-08-05 |
| Find all providers with the same taxonomy | ||||
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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.