| Pdg, Pa | |
|
7501 80th St S #214 Cottage Grove MN 55016-3020 | |
| (651) 459-2300 | |
| (651) 458-1836 |
| Full Name | Pdg, Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 7501 80th St S, Cottage 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 |
|---|---|
| Pdg, Pa 2200 County Road C W #2210 Roseville MN 55113-2550 Ph: (651) 746-2815 | Pdg, Pa 7501 80th St S #214 Cottage Grove MN 55016-3020 Ph: (651) 459-2300 |
| NPI Number | 1689122442 |
|---|---|
| Provider Enumeration Date | 09/21/2016 |
| Last Update Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689122442 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D8289 (Minnesota) | Primary |
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