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General NPI Number Information
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NPI Number | 1568278489
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Entity Type | Organization
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Legal Business Name | PDC CLINICAL PLLC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 717 S WHITE STATION RD STE 7
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City | MEMPHIS
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State | TN
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Zip | 38117-4538
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Country | US
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Telephone | 901-363-8192
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Fax | 901-375-9310
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Provider Business Mailing Address
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Address Line | 5286 COLE RD
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City | MEMPHIS
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State | TN
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Zip | 38120-2402
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Country | US
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Telephone | 901-481-5791
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. HUNTER ACOSTA
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Credential |
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Telephone | 901-481-5791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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