Organization
PEDIATRIC DENTAL ASSOCIATES OF CULLMAN, LLC
Active
Other names
Nassetta Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD CHAMBLISS DDS (OWNER)
(205) 453-0314
Entity
Organization
Contact information
Practice address
1705 MAIN AVE SW STE A, CULLMAN, AL 35055-7207
(256) 739-6000
Mailing address
1705 MAIN AVE SW STE A, CULLMAN, AL 35055-7207
(256) 739-6000
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0005181
AL
Other
Enumeration date
01/30/2018
Last updated
01/30/2018
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