Organization
PDA ORTHODONTICS TRUSSVILLE PLLC
Active
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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