| Pdg, PA | |
|
3780 Marketplace Dr Nw Ste 112 Rochester MN 55901-3225 | |
| (507) 288-1633 | |
| (507) 288-2716 |
| Full Name | Pdg, PA |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3780 Marketplace Dr Nw Ste 112, Rochester, 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 55113-2550 Ph: (651) 636-6350 | Pdg, PA 3780 Marketplace Dr Nw Ste 112 Rochester MN 55901-3225 Ph: (507) 288-1633 |
| NPI Number | 1396199832 |
|---|---|
| Provider Enumeration Date | 04/21/2016 |
| Last Update Date | 07/21/2022 |
| Certification Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396199832 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (NU) | Primary |
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