| Full Name | Pdg, Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4155 Dean Lakes Blvd, Shakopee, Minnesota |
| Authorized Official Name and Position | John Gulon (PRESIDENT) |
| Authorized Official Contact | 6516330500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pdg, Pa 2200 County Road C W Ste 2210 Roseville MN 55113-2551 Ph: (651) 636-6350 | Pdg, Pa 4155 Dean Lakes Blvd Shakopee MN 55379 Ph: (952) 303-8320 |
| NPI Number | 1821545930 |
|---|---|
| Provider Enumeration Date | 09/07/2016 |
| Last Update Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821545930 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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