| Pdg, P.a. | |
|
4891 Miller Truck Hwy. Suite 100 Hermantown MN 55811 | |
| (218) 722-7770 | |
| (218) 740-3234 |
| Full Name | Pdg, P.a. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4891 Miller Truck Hwy., Hermantown, Minnesota |
| Authorized Official Name and Position | Shannon Hesse (CREDENTIALING SPECIALISTS) |
| Authorized Official Contact | 6517462815 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pdg, P.a. 2200 County Road C W Ste 2210 Roseville MN 55113-2551 Ph: (651) 746-2815 | Pdg, P.a. 4891 Miller Truck Hwy. Suite 100 Hermantown MN 55811 Ph: (218) 722-7770 |
| NPI Number | 1184288979 |
|---|---|
| Provider Enumeration Date | 04/26/2019 |
| Last Update Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184288979 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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