NPIMap

Organization Active NPI

Pediatric Dental Associates of Cullman, LLC

  • Dental Clinic/Center
  • Cullman, AL
National Provider Identifier
1609374164
Registry record updated Jan 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
0005181 Issued in AL
Legal business name
PEDIATRIC DENTAL ASSOCIATES OF CULLMAN, LLC
Practice address
1705 Main Ave SW Ste a
Cullman, AL 35055-7207
Phone
(256) 739-6000
NPI assigned
Jan 30, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2018

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

Authorized official

Name
Dr. Richard Chambliss, DDSNPI 1770527707
Title
Owner
Phone
(205) 453-0314

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 0005181 AL Primary

Addresses

Primary practice location

1705 Main Ave SW Ste a
Cullman, AL 35055-7207

Mailing address

1705 Main Ave SW Ste a
Cullman, AL 35055-7207
Phone (256) 739-6000

Other names 1

  • Nassetta Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1907 Main Ave SW
#B
Cullman, AL 35055

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517270400000",
    "number": "1609374164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 MAIN AVE SW STE A",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350557207",
            "telephone_number": "256-739-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 MAIN AVE SW STE A",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350557207",
            "telephone_number": "256-739-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL ASSOCIATES OF CULLMAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-30",
        "last_updated": "2018-01-30",
        "status": "A",
        "authorized_official_last_name": "CHAMBLISS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "205-453-0314",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AL",
            "license": "0005181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nassetta Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cullman, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2018; 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.