NPI 1396120473

Pdg, PA

Organisation Dental Clinic/Center Lake Elmo, MN

Practice location

Address: 8650 Hudson Blvd N Suite 105, Lake Elmo, MN 55042
Phone: (651) 379-0564
Fax: (651) 501-1471
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: 1396120473
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.