Provider Demographics
NPI:1063387652
Name:PDC OF MEMPHIS 3 PLLC
Entity type:Organization
Organization Name:PDC OF MEMPHIS 3 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-363-8192
Mailing Address - Street 1:5286 COLE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2402
Mailing Address - Country:US
Mailing Address - Phone:901-363-8192
Mailing Address - Fax:
Practice Address - Street 1:5040 SANDERLIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4374
Practice Address - Country:US
Practice Address - Phone:901-363-8192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PDC CLINICAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty