Benjamin E Samuelson, DMD, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

6358C1 Issued in AL

Practice address

5564 Grove Blvd Ste a
Hoover, AL 35226-4601

Phone

(205) 988-9678

NPI assigned

Jul 25, 2017

Last updated

Sep 12, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pda Orthodontics, LLC

  dba Medplex Pediatric Dentistry

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Hoover, AL
  • NPI 1942855176
  NPD Authorized official
• Pda Orthodontics Trussville PLLC

  dba Trussville Pediatric Dentistry

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Trussville, AL
  • NPI 1043815590
  Authorized official Same address or phone
• Pediatric Dental Associates of Hoover, LLC

  dba PDA of Hoover, LLC

  • Pediatric Dentistry
  • Hoover, AL
  • NPI 1043954647
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1215450952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5564 GROVE BLVD STE A",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352264601",
            "telephone_number": "205-988-9678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5564 GROVE BLVD STE A",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352264601",
            "telephone_number": "205-988-9678"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 Southlake Park Ste 200",
            "address_purpose": "LOCATION",
            "city": "Hoover",
            "state": "AL",
            "postal_code": "352443615",
            "country_code": "US",
            "telephone_number": "205-453-0314 x2",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "BENJAMIN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-25",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AL",
            "license": "6358C1",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AL",
            "license": "6358C1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Raygan Salors, ALC
• Sam's Club Optical (Sam's Club Optical 30-4724)
• Abnous Abbey Samford, O.D.
• Laken Samford, MS, OTR
• Sams East Inc (Sams Pharmacy 10-4724)
• Jennifer Sanders, OTR/L
• Jonathan Sanders, MS, CRC, LPC
• James Lester Sanderson Jr., D.M.D.
• Robert E Sanderson, D.M.D.
• Trinity Sakura Sandlin

• Orthodontics and Dentofacial Orthopedics Dentistry in Hoover, AL
• Providers in Hoover, AL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.