PDG, P.A. (NPI# 1487712915) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487712915 |
| Entity Type | Organization |
| Organization Name | PDG, P.A. |
| Other Organization Name | PARK DENTAL |
| Practice Address |
9600 Upland Ln N Suite 200 Maple Grove MN 55369-4461 |
| Mailing Address |
2200 County Road C W Suite 2210 Roseville MN 55113-2504 |
| Practice Telephone | 7634160037 |
| Practice Fax Number | 7634205428 |
| Mailing Telephone | 6516330500 |
| Mailing Fax Number | 6516366350 |
| Enumeration Date | 2006-12-05 |
| 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 |
|---|---|---|---|---|
| 1184288979 | Pdg, P.a. | Clinic/Center | 4891 Miller Truck Hwy., Suite 100, Hermantown, MN 55811 | 2019-04-26 |
| 1316376668 | Pdg, P.a. | Clinic/Center | 6520 150th St W, Suite 300, Apple Valley, MN 55124-6554 | 2013-11-07 |
| 1639508153 | Pdg, P.a. | Clinic/Center | 501 Cherry Ln, Roberts, WI 54023-9731 | 2013-11-05 |
| 1043649569 | Pdg, P.a. | Clinic/Center | 1003 Pearson Dr, Hudson, WI 54016-8727 | 2013-11-05 |
| 1205265741 | Pdg, P.a. | Clinic/Center | 10150 City Walk Dr, Suite C, Woodbury, MN 55129-9257 | 2013-11-05 |
| 1538598057 | Pdg, P.a. | Clinic/Center | 15015 Cimarron Ave, Rosemount, MN 55068-2771 | 2013-11-05 |
| 1346679859 | Pdg, P.a. | Clinic/Center | 14741 Victor Hugo Blvd N, Hugo, MN 55038-4561 | 2013-11-05 |
| 1285993345 | Pdg, P.a. | Clinic/Center | 3161 Northdale Blvd Nw, Coon Rapids, MN 55433-1825 | 2012-05-10 |
| 1104985456 | Pdg, P.a. | Dentist | 1835 Cty Rd C-west, Suite 220, Roseville, MN 55113-1343 | 2006-12-06 |
| 1710045117 | Pdg, P.a. | Dentist | 5350 S Robert Trl, Inver Grove Heights, MN 55077-1404 | 2006-12-05 |
| Street Address |
9600 UPLAND LN N SUITE 200 |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-4461 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205209558 | Danielle Baker | Marriage & Family Therapist | 9600 Upland Ln N, Suite 110, Maple Grove, MN 55369-4494 | 2015-11-09 |
| 1851703789 | Jeffrey Allen Pumper | Dentist | 9600 Upland Ln N, Suite 200, Maple Grove, MN 55369-4494 | 2014-05-27 |
| 1083946081 | Rachel Mae Clark | Genetic Counselor, MS | 9600 Upland Ln N, Ste 180, Maple Grove, MN 55369-4494 | 2010-02-02 |
| 1558696583 | Allina Health System | Clinic/Center | 9600 Upland Ln N, Maple Grove, MN 55369-4494 | 2009-10-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| 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 |
|---|---|---|---|---|
| 1942793989 | Lyle Arrian Corpuz Carlos | Dentist | 12737 Elm Creek Blvd N, Maple Grove, MN 55369-7045 | 2018-06-13 |
| 1346770500 | Hyeok Je Lee | Dentist | 6240 Quinwood Ln N # 100, Maple Grove, MN 55369-6384 | 2017-06-19 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1326481284 | Grove Dentist Pa | Dentist | 13649 Grove Dr, Maple Grove, MN 55311-4405 | 2013-04-10 |
| 1619259181 | Cedar Island Dental | Dentist | 7378 Kirkwood Ct N, Maple Grove, MN 55369-5270 | 2011-09-12 |
| 1417240243 | Jennifer Marie Bertrand | Dentist | 7270 Forestview Ln N Ste 250, Maple Grove, MN 55369-5605 | 2011-05-26 |
| 1740508704 | Partners In Dentistry Ltd | Dentist | 17143 73rd Pl N, Maple Grove, MN 55311-2686 | 2010-05-13 |
| 1639337710 | Blue Ridge Dental Center Pa | Dentist | 13800 83rd Way N Ste 100, Maple Grove, MN 55369-7016 | 2008-05-27 |
| 1699977058 | Jodi Marie Burth | Dentist | 11256 86th Ave N, Maple Grove, MN 55369 | 2007-06-05 |
| 1124230800 | Matthew P Dale Dds Pa | Dentist | 13998 Maple Knoll Way # Ll103, Maple Grove, MN 55369-7004 | 2007-05-04 |
| Find all providers in MAPLE GROVE | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
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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.