Provider Demographics
NPI:1043978083
Name:JSCC ENTERPRISES PLLC
Entity type:Organization
Organization Name:JSCC ENTERPRISES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KALEB
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:901-452-0040
Mailing Address - Street 1:3491 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4630
Mailing Address - Country:US
Mailing Address - Phone:901-452-0040
Mailing Address - Fax:901-452-1909
Practice Address - Street 1:3491 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4630
Practice Address - Country:US
Practice Address - Phone:901-452-0040
Practice Address - Fax:901-452-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty