Pda of Trussville

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PDA OF TRUSSVILLE

Practice address

4643 Camp Coleman Rd Ste 101
Trussville, AL 35173-2838

Phone

(678) 628-8303

Fax

(256) 285-1485

NPI assigned

Apr 30, 2024

Last updated

May 5, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Richard Baker Chambliss, DMDNPI 1770527707

Title

Owner

Phone

(205) 453-0314

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard Baker Chambliss Jr., D.M.D

  • Pediatric Dentistry
  • Hoover, AL
  • NPI 1770527707
  NPD (past) Authorized official

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

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714867200000",
    "number": "1841046703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 CROPWELL DR STE 2",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351287552",
            "telephone_number": "678-628-8303",
            "fax_number": "256-285-1485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4643 CAMP COLEMAN RD STE 101",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351732838",
            "telephone_number": "678-628-8303",
            "fax_number": "256-285-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDA OF TRUSSVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-05-05",
        "certification_date": "2024-05-05",
        "status": "A",
        "authorized_official_last_name": "CHAMBLISS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "BAKER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "205-453-0314",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Onsite Solutions, LLC
• Orthosports Associates, LLC
• Jennifer Lucy Otwell, LICSW
• Katelyn Skipper Owens
• Masum Patel
• Pda Orthodontics Trussville PLLC (Trussville Pediatric Dentistry)
• Pediatric Dentistry East, LLC
• Sarah Robertson Pendleton, MSW, LCSW
• Kristin Swindle Penuel, ALC
• Deena Lynn Phillips, RPH

• Pediatric Dentistry in Trussville, AL
• Providers in Trussville, AL by specialty
• Pediatric Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2024; 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.