Healthcare Provider Details

I. General information

NPI: 1063387652
Provider Name (Legal Business Name): PDC OF MEMPHIS 3 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 SANDERLIN AVE STE 101
MEMPHIS TN
38117-4374
US

IV. Provider business mailing address

5286 COLE RD
MEMPHIS TN
38120-2402
US

V. Phone/Fax

Practice location:
  • Phone: 901-363-8192
  • Fax:
Mailing address:
  • Phone: 901-363-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ACOSTA
Title or Position: OWNER
Credential: DDS
Phone: 901-363-8192