NPIMap

Organization Active NPI

PDC of Memphis 3 PLLC

  • Pediatric Dentistry
  • Memphis, TN
National Provider Identifier
1063387652
Registry record updated Oct 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
PDC OF MEMPHIS 3 PLLC
Practice address
5040 Sanderlin Ave Ste 101
Memphis, TN 38117-4374
Phone
(901) 363-8192
NPI assigned
Oct 6, 2025
Organization subpart
Yes
Parent organization
PDC CLINICAL PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John Acosta, DDSNPI 1841356169
Title
Owner
Phone
(901) 363-8192

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X

Addresses

Primary practice location

5040 Sanderlin Ave Ste 101
Memphis, TN 38117-4374

Mailing address

5286 Cole Rd
Memphis, TN 38120-2402
Phone (901) 363-8192

National Provider Directory

National Provider Directory

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1759708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759708800000",
    "number": "1063387652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5286 COLE RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202402",
            "telephone_number": "901-363-8192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5040 SANDERLIN AVE STE 101",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381174374",
            "telephone_number": "901-363-8192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDC OF MEMPHIS 3 PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PDC CLINICAL PLLC",
        "enumeration_date": "2025-10-06",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A",
        "authorized_official_last_name": "ACOSTA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-363-8192",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.