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Organization
PDA OF TRUSSVILLE
Active
Organization
PDA OF TRUSSVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD BAKER CHAMBLISS DMD (OWNER)
(205) 453-0314
Entity
Organization
Contact information
Practice address
4643 CAMP COLEMAN RD STE 101, TRUSSVILLE, AL 35173-2838
(678) 628-8303
(256) 285-1485
Mailing address
50 CROPWELL DR STE 2, PELL CITY, AL 35128-7552
(678) 628-8303
(256) 285-1485
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
NULL
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
NULL
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
04/30/2024
Last updated
05/05/2024
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