FACIAL PAIN CENTER – NPI #1396120473
Clinic/Center

FACIAL PAIN CENTER is an AHC clinic located in LAKE ELMO, MN. NPPES has assigned the NPI number 1396120473 to FACIAL PAIN CENTER on July 30, 2015. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “FACIAL PAIN CENTER” is a dba name, the actual legal business name for this organization is PDG, PA. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

The NPI profile was previously updated about 6 years ago on Oct 28, 2020. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for FACIAL PAIN CENTER below.

NPI Profile for
PDG, PA

NPI Number
1396120473
Enumeration Date

(about 11 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PDG, PA
Doing Business As (dba): FACIAL PAIN CENTER
Primary location
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
Phone: (651) 633-0500 Fax: (651) 636-6350
Organization Subpart
Yes - FACIAL PAIN CENTER is subpart of another organization.
Authorized Official
JOHN GULON
PRESIDENT
Phone: (651) 633-0500
Updated
Certification Date
Oct 28, 2020

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.