Pdg, P.A
Clinic/Center, Dental in Plymouth, MN. Organization (NPI-2).
NPI number1366096513
StatusActive
Last updated in NPPESOct 28, 2020
Details
- NPI
- 1366096513
- Entity type
- Organization (NPI-2)
- Legal business name
- Pdg, P.A
- Organization subpart
- No
- Enumeration date
- Jul 26, 2019
- Certification date
- Oct 28, 2020
- Last updated
- Oct 28, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Other names
- Park Dental Plymouth Lakes (Doing Business As)
Practice location
1525 County Road 101 NPlymouth, MN 55447-2707
Phone 763-475-2829
Mailing address
2200 County Road C W Ste 2210Roseville, MN 55113-2551
Phone 651-746-2815
Authorized official
Shannon Hesse
Credentialing Specialist
6517462815
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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