| Park Dental | |
|
9600 Upland Ln N Suite 200 Maple Grove MN 55369-4461 | |
| (763) 416-0037 | |
| (763) 420-5428 |
| Full Name | Park Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9600 Upland Ln N, Maple Grove, 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 |
|---|---|
| Park Dental 2200 County Road C W Suite 2210 Roseville MN 55113-2504 Ph: (651) 633-0500 | Park Dental 9600 Upland Ln N Suite 200 Maple Grove MN 55369-4461 Ph: (763) 416-0037 |
| NPI Number | 1487712915 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 10/28/2020 |
| Certification Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487712915 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (NU) | Primary |
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