Provider Demographics
NPI:1659910933
Name:JCDSM PLLC
Entity Type:Organization
Organization Name:JCDSM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:CORBET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-354-0606
Mailing Address - Street 1:2205 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3607
Mailing Address - Country:US
Mailing Address - Phone:817-354-0606
Mailing Address - Fax:817-354-1015
Practice Address - Street 1:2205 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3607
Practice Address - Country:US
Practice Address - Phone:817-354-0606
Practice Address - Fax:817-354-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment