Organization
PDA ORTHODONTICS TRUSSVILLE PLLC
Active
Other names
Trussville Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN EARL SAMUELSON DMD, MS (OWNER/ORTHODONTIST)
(205) 910-0143
Entity
Organization
Contact information
Practice address
4901 DEERFOOT PKWY STE 101, TRUSSVILLE, AL 35173-2697
(205) 508-7135
Mailing address
5336 STADIUM TRACE PKWY STE 112, HOOVER, AL 35244-4581
(205) 988-9678
(205) 988-9065
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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