Healthcare Provider Details

I. General information

NPI: 1568278489
Provider Name (Legal Business Name): PDC CLINICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S WHITE STATION RD STE 7
MEMPHIS TN
38117-4538
US

IV. Provider business mailing address

5286 COLE RD
MEMPHIS TN
38120-2402
US

V. Phone/Fax

Practice location:
  • Phone: 901-363-8192
  • Fax: 901-375-9310
Mailing address:
  • Phone: 901-481-5791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. HUNTER ACOSTA
Title or Position: CEO
Credential:
Phone: 901-481-5791