PDG, P.A. (NPI# 1962760462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962760462 |
| Entity Type | Organization |
| Organization Name | PDG, P.A. |
| Other Organization Name | PARK DENTAL |
| Practice Address |
511 Elm St Farmington MN 55024-1126 |
| Mailing Address |
2200 County Road C W Suite 2210 Roseville MN 55113-2550 |
| Practice Telephone | 9523037028 |
| Mailing Telephone | 6516330500 |
| Mailing Fax Number | 6516366894 |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2020-10-28 |
| Authorized Official Name | DR. JOHN GULON (PRESIDENT) |
| Authorized Official Telephone | 6516330500 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| 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 |
| 1487712915 | Pdg, P.a. | Dentist | 9600 Upland Ln N, Suite 200, Maple Grove, MN 55369-4461 | 2006-12-05 |
| Street Address |
511 ELM ST |
| City | FARMINGTON |
| State | MN |
| Zip Code | 55024-1126 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548226327 | Linden K Dungy | Dentist | 511 Elm St, Farmington, MN 55024-1126 | 2006-04-21 |
| 1417070509 | Immanuel Dental | Dentist | 511 Elm St, Farmington, MN 55024-1126 | 2007-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932758158 | Renetia Jackson | Technician | 1210 Spruce Street, Farmington, MN 55024 | 2019-09-10 |
| 1871094912 | Megan Provost | Registered Nurse | 17680 Formosa Ave, Farmington, MN 55024 | 2018-02-23 |
| 1356752463 | Your Vision Achieved, LLC | Marriage & Family Therapist | 5404 187th Street West, Farmington, MN 55024 | 2014-05-12 |
| 1427304203 | Joseph Samuel Emond Jr. | Family Medicine | 19730 Meadowlark Way, Farmington, MN 55024 | 2012-07-30 |
| 1053680991 | Annie Lee Mickelson | Chiropractor | 20700 Chippendale Ave Suite 7, Farmington, MN 55024 | 2011-12-21 |
| 1770770828 | Grand St Paul Cvs LLC | Durable Medical Equipment & Medical Supplies | 19605 Pilot Knob Rd., Farmington, MN 55024 | 2007-10-02 |
| 1275725277 | Family Vision Clinic of Farmington | Optometrist | 19650 Pilot Knob Road, Farmington, MN 55024 | 2007-08-14 |
| 1871503136 | Independent School District #192 | Early Intervention Provider Agency | 20655 Flagstaff Avenue, Farmington, MN 55024 | 2006-08-09 |
| 1588692669 | Northfield Hospital | Clinic/Center | 4645 Knutsen Dr, Farmington, MN 55024 | 2006-06-29 |
| 1902887284 | David E Truax | Chiropractor | 20700 Chippendale Ave, Suite 7, Farmington, MN 55024 | 2005-11-14 |
| Find all providers in zip 55024 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689159147 | Station Park Dental LLC | Clinic/Center | 1060 W Park Ln Ste 110, Farmington, UT 84025-2992 | 2018-10-01 |
| 1285887448 | Timothy M. O'bryan Dds, LLC | Clinic/Center | 12 E Harrison St, Farmington, MO 63640-1859 | 2008-10-30 |
| 1053923656 | Family Dentistry of Farmington | Clinic/Center | 24001 Orchard Lake Rd Ste 160, Farmington, MI 48336-2553 | 2020-08-17 |
| 1619514718 | Farmington Dental Pllc | Clinic/Center | 200 Mountain Rd, Farmington, CT 06032-2479 | 2019-12-08 |
| 1619446077 | Cordell Lake, D.d.s., LLC | Clinic/Center | 12 E Harrison St, Farmington, MO 63640-1859 | 2018-11-15 |
| 1598193088 | Derek Graff Dmd Ltd | Clinic/Center | 3180 N Butler Ave, Bldg 200, Farmington, NM 87401-2334 | 2013-10-22 |
| 1417200932 | Compassion Dental 06032 | Clinic/Center | 222 Main St, #251, Farmington, CT 06032-3623 | 2012-10-22 |
| 1679740013 | San Juan College | Clinic/Center | 4601 College Blvd, Dental Clinic, Farmington, NM 87402-4609 | 2008-05-14 |
| 1295937977 | Westmount Dental Arts | Clinic/Center | 1273 Doctors Dr, Farmington, MO 63640-2947 | 2007-06-04 |
| 1922029768 | University Dentists | Clinic/Center | 263 Farmington Ave, Mc2105, Farmington, CT 06030-0001 | 2006-07-21 |
| Find all providers in FARMINGTON | ||||
| City | FARMINGTON |
| Zip Code | 55024 |
Please comment or provide details below to improve the information on PDG, P.A..
| 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.