Organization
PDA ORTHO CULLMAN LLC
Active
Other names
Cullman Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
MALLORY SAMUELSON (OPERATIONS MANAGER)
(615) 631-9226
Entity
Organization
Contact information
Practice address
1907 MAIN AVE SW STE A, CULLMAN, AL 35055-5218
(256) 279-9852
Mailing address
5564 GROVE BLVD STE A, HOOVER, AL 35226-4601
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
07/22/2021
Last updated
09/12/2023
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