| Pda Orthodontics Trussville Pllc | |
|
4901 Deerfoot Pkwy Ste 101 Trussville AL 35173-2697 | |
| (205) 508-7135 | |
| Not Available |
| Full Name | Pda Orthodontics Trussville Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 4901 Deerfoot Pkwy Ste 101, Trussville, Alabama |
| Authorized Official Name and Position | Benjamin Earl Samuelson (OWNER/ORTHODONTIST) |
| Authorized Official Contact | 2059100143 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pda Orthodontics Trussville Pllc 5336 Stadium Trace Pkwy Ste 112 Hoover AL 35244-4581 Ph: (205) 988-9678 | Pda Orthodontics Trussville Pllc 4901 Deerfoot Pkwy Ste 101 Trussville AL 35173-2697 Ph: (205) 508-7135 |
| NPI Number | 1043815590 |
|---|---|
| Provider Enumeration Date | 12/02/2020 |
| Last Update Date | 12/02/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043815590 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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