Organization
PDA ORTHO CULLMAN LLC
Active
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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