| Pdg, PA | |
|
11091 Jason Ave Ne Suite 3 Albertville MN 55301-4699 | |
| (763) 497-2822 | |
| (763) 497-2955 |
| Full Name | Pdg, PA |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 11091 Jason Ave Ne, Albertville, 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 Suite 2210 Roseville MN 55113-2550 Ph: (651) 633-0500 | Pdg, PA 11091 Jason Ave Ne Suite 3 Albertville MN 55301-4699 Ph: (763) 497-2822 |
| NPI Number | 1366826752 |
|---|---|
| Provider Enumeration Date | 07/15/2015 |
| Last Update Date | 10/28/2020 |
| Certification Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366826752 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Primary |
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