PDG, PA (NPI# 1629589544) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1629589544 |
Entity Type | Organization |
Organization Name | PDG, PA |
Other Organization Name | PARK DENTAL |
Practice Address |
16991 198th Ave Nw Big Lake MN 55309 |
Mailing Address |
2200 County Road C W Ste 2210 Roseville MN 55113-2551 |
Practice Telephone | 7632636350 |
Practice Fax Number | 7632630136 |
Mailing Telephone | 6517462815 |
Mailing Fax Number | 6512096312 |
Enumeration Date | 2017-10-18 |
Last Update Date | 2020-10-28 |
Authorized Official Name | SHANNON HESSE (CREDENTIALING SPECIALIST) |
Authorized Official Telephone | 6517462815 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Park Dental | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1649838343 | Pdg, Pa | Clinic/Center | 7774 Hargis Pkwy Ste 106, Woodbury, MN 55129-2305 | 2019-05-29 |
1861931545 | Pdg, Pa | Clinic/Center | 605 Hillcrest Ave Ste 210, Owatonna, MN 55060-3680 | 2017-02-15 |
1285170464 | Pdg, Pa | Clinic/Center | 18230 Zane St Nw, Elk River, MN 55330-4501 | 2017-01-12 |
1518403831 | Pdg, Pa | Clinic/Center | 324 W Superior St Ste 1130, Duluth, MN 55802-1714 | 2017-01-10 |
1396199832 | Pdg, Pa | Clinic/Center | 3780 Marketplace Dr Nw Ste 112, Rochester, MN 55901-3225 | 2016-04-21 |
1598128647 | Pdg, Pa | Clinic/Center | 14170 Highway 13 S, Savage, MN 55378-2587 | 2016-04-05 |
1144780420 | Pdg, Pa | Clinic/Center | 906 Woodland Ave, Duluth, MN 55812-1113 | 2019-03-22 |
1689122442 | Pdg, Pa | Clinic/Center | 7501 80th St S, #214, Cottage Grove, MN 55016-3020 | 2016-09-21 |
1346798600 | Pdg, Pa | Clinic/Center | 901 Marquette Ave Ste 230, Minneapolis, MN 55402-3260 | 2016-09-15 |
1821545930 | Pdg, Pa | Clinic/Center | 4155 Dean Lakes Blvd, Shakopee, MN 55379 | 2016-09-07 |
Street Address |
16991 198TH AVE NW |
City | BIG LAKE |
State | MN |
Zip Code | 55309 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235797820 | Neeharika Bhashyam | Dentist | 16991 198th Ave Nw, Big Lake, MN 55309-4927 | 2019-05-30 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1356986475 | Barbro E Strom Langley | Technician | 16901 River View Cir, Big Lake, MN 55309 | 2019-11-13 |
1669821765 | Laura Ann Dill | Dentist | 290 Eagle Lake Rd N, Big Lake, MN 55309 | 2016-06-09 |
1295008068 | Cherrywood Advanced Living, LLC | Assisted Living Facility | 171 Henry Road, Big Lake, MN 55309 | 2012-02-09 |
1013280882 | Cherrywood Advanced Living, LLC | Assisted Living Facility | 177 Henry Road, Big Lake, MN 55309 | 2012-02-09 |
1760704712 | Mary Ellen Venzke | Adult Companion | 19729 183rd Avenue, Big Lake, MN 55309 | 2010-02-18 |
1174700611 | Country Services Inc | Case Management | 641 Park Ave E, Big Lake, MN 55309 | 2008-01-28 |
1942481593 | Monticello Dental Group | Dentist | 20460 Co. Rd.11 Nw, Big Lake, MN 55309 | 2007-11-23 |
1336367242 | Family Prospective Resources, Inc | Marriage & Family Therapist | 35 Lake St So, Big Lake, MN 55309 | 2007-04-23 |
1598983470 | Jennifer Ann Lawrence | Marriage & Family Therapist | 35 Lake Street South #200, Big Lake, MN 55309 | 2007-04-23 |
1760548085 | Nathan E. Davidson | Chiropractor | 670 Humboldt Drive, Big Lake, MN 55309 | 2006-12-29 |
Find all providers in zip 55309 |
Taxonomy Code | 261QD0000X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Dental |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1740745439 | Susan Olson Dmd Inc | Clinic/Center | 3261 S. Big Lake Rd. Ste D3-d4, Big Lake, AK 99652 | 2019-02-06 |
1013328608 | Ks Holdings Pa | Clinic/Center | 751 Rose Dr Nw, Suite 108, Big Lake, MN 55309-8705 | 2014-05-16 |
1396971412 | Reed D. Dill, D.d.s. P.a. | Clinic/Center | 171 Lake St N, Big Lake, MN 55309-9254 | 2009-06-03 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1033710025 | Theresa M. Snell | Clinic/Center | 580 5th Ave Nw Ste 100, New Brighton, MN 55112-2836 | 2020-11-05 |
1376143248 | James M. Williams, D.d.s., P.a. | Clinic/Center | 620 Union St S, Mora, MN 55051-1818 | 2020-10-29 |
1235746058 | Asp Dental, PC | Clinic/Center | 17705 Hutchins Dr Ste 201, Minnetonka, MN 55345-4103 | 2020-09-25 |
1952918781 | Asp Dental, PC | Clinic/Center | 9800 Shelard Pkwy Ste 130, Plymouth, MN 55441-6451 | 2020-09-25 |
1518574532 | Stillwater Family Dental | Clinic/Center | 13481 60th St N Ste 100, Oak Park Heights, MN 55082-1089 | 2020-09-24 |
1093321531 | Barnett Dental Inc | Clinic/Center | 7962 Sunwood Dr Nw Ste 200, Ramsey, MN 55303-5172 | 2020-09-21 |
1356955868 | Todd A Brewer Dds Pllc | Clinic/Center | 603 Jefferson Ave Sw, Watertown, MN 55388 | 2020-09-02 |
1770195158 | Mark T. Sherman Dds Pa | Clinic/Center | 31011 Rasmussen Rd, Pequot Lakes, MN 56472-1227 | 2020-08-18 |
1689286015 | Lifelong Dental Care | Clinic/Center | 1525 Livingston Ave Ste B, West St Paul, MN 55118-3430 | 2020-08-18 |
1528678497 | Custom Smiles Dentistry, Pllc | Clinic/Center | 2258 Bunker Lake Blvd Nw, Andover, MN 55304-3900 | 2020-08-05 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.