JDC HEALTHCARE, PLLC
Complete NPI Record 1003017096
Dentist - General Practice in Dallas, TX

NPI Status: Active since May 29, 2007

Contact Information

3010 LYNDON B JOHNSON FWY
SUITE 200
DALLAS, TX
ZIP 75234
Phone: (972) 444-8888
Fax: (972) 488-1899

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Complete NPI Dataset

The following table represents the complete dataset for NPI number 1003017096. The table includes a list of all field names, values and definitions of the full NPI record. This dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.

Name Value Definition
NPI1003017096The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameJDC HEALTHCARE, PLLCThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address3030 LBJ FWYThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing AddressSUITE 1400The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City NameDALLASThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameTXThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code752347781The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number9724448888The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number9724881899The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address3010 LYNDON B JOHNSON FWYThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 200The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameDALLASThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameTXThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code752347770The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number9724448888The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number9724881899The fax number associated with the location address of the provider being identified.
Provider Enumeration Date5/29/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date3/18/2024The date that a record was last updated or changed.
Authorized Official Last NameCORDELLThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NamePHILIPThe first name of the authorized official.
Authorized Official Title or PositionDENTIST OWNERThe title or position of the authorized official.
Authorized Official Telephone Number9724448888The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 11223G0001XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 114391The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1TXThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Is Organization SubpartN
Authorized Official Name Prefix TextDR.
Healthcare Provider Taxonomy Group 1193400000X SINGLE SPECIALTY GROUP
NPI Certification Date3/18/2024