Provider Demographics
NPI:1053775890
Name:JDC HEALTHCARE MANAGEMENT , PLLC
Entity type:Organization
Organization Name:JDC HEALTHCARE MANAGEMENT , PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-658-8979
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:972-243-6059
Practice Address - Street 1:5334 ROSS AVE
Practice Address - Street 2:STE. 800
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7453
Practice Address - Country:US
Practice Address - Phone:214-841-4200
Practice Address - Fax:214-823-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31642122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty