Fl Southern Dental Ppo PA

NPI #1053126573 in Aventura, Florida

Provider Information

NPI Number: 1053126573
Entity Type: Organization
Organization Name: Fl Southern Dental Ppo PA
Subpart: Yes (part of a larger organization)
Parent Organization: FL SOUTHERN DENTAL PPO PA
Primary Specialty: Dentist
Enumeration Date: Feb 11, 2025
Last Updated: Feb 11, 2025

Practice Location

Address: 21355 E DIXIE HWY STE 105
City: Aventura
State: Florida
ZIP Code: 33180-1239
Phone: (305) 935-3157

Authorized Official

Name: ERIKA MELISSA MENJIVAR
Title: SR. CREDENTIALING SPECIALIST
Phone: (469) 596-6137

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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