Provider Demographics
NPI:1003017096
Name:JDC HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:JDC HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-444-8888
Mailing Address - Street 1:3030 LBJ FWY
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7781
Mailing Address - Country:US
Mailing Address - Phone:972-444-8888
Mailing Address - Fax:972-488-1899
Practice Address - Street 1:3010 LYNDON B JOHNSON FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7770
Practice Address - Country:US
Practice Address - Phone:972-444-8888
Practice Address - Fax:972-488-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty