NPI 1104201284

Pdg, PA

Organisation Dental Clinic/Center Roseville, MN

Practice location

Address: 1835 County Road C W Suite 200, Roseville, MN 55113
Phone: (651) 209-7088
Fax: (651) 636-1118
Mailing address: 2200 County Road C W Suite 2210, Roseville, MN 55113-2550

Authorised official

Name: John Gulon
Title: President
Phone: (651) 633-0500

Registered specialties

Dental Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QD0000X

Other Clinic/Center providers in Minnesota →

Registry record

NPI: 1104201284
Entity type: Organization
NPI issued: 30 Jul 2015
Record last updated: 28 Oct 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.