NPIMap

Organization Active NPI

Pda Orthodontics, LLC

Doing business as Medplex Pediatric Dentistry

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Hoover, AL
National Provider Identifier
1942855176
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
PDA ORTHODONTICS, LLC
Doing business as
Medplex Pediatric Dentistry
Samuelson Orthodontics
Practice address
5564 Grove Blvd Ste a
Hoover, AL 35226-4601
Phone
(205) 988-9678
Fax
(205) 988-9065
NPI assigned
Aug 5, 2019
Last updated
Sep 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Authorized official

Name
Dr. Benjamin Earl Samuelson, DMD, MSNPI 1215450952
Title
Orthodontist/Partner
Phone
(205) 910-0143

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
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU Primary

Addresses

Primary practice location

5564 Grove Blvd Ste a
Hoover, AL 35226-4601

Mailing address

5564 Grove Blvd Ste a
Hoover, AL 35226-4601
Phone (205) 988-9678

Other practice location 1

3000 Southlake Park Ste 200
Hoover, AL 35244-3615
Phone (205) 453-0314

Other names 2

  • Medplex Pediatric Dentistry Doing business as
  • Samuelson Orthodontics Doing business as

National Provider Directory

National Provider Directory

Locations

3000 Southlake Park
Ste 200
Hoover, AL 35244
Phone 2054530314 ext. 2

5564 Grove Blvd
Ste A
Hoover, AL 35226
Phone (205) 988-9678

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1564963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1942855176",
    "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",
            "fax_number": "205-988-9065"
        },
        {
            "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",
            "fax_number": "205-988-9065"
        }
    ],
    "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",
            "fax_number": "205-453-0315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PDA ORTHODONTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-05",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "SAMUELSON",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "ORTHODONTIST/PARTNER",
        "authorized_official_telephone_number": "205-910-0143",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medplex Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Samuelson Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hoover, AL

Sources for this page

  • 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.