Va Southern Dental Ppo PC

NPI #1053293746 in Fredericksburg, Virginia

Provider Information

NPI Number: 1053293746
Entity Type: Organization
Organization Name: Va Southern Dental Ppo PC
Subpart: Yes (part of a larger organization)
Parent Organization: VA SOUTHERN DENTAL PPO PC
Primary Specialty: Dentist
Enumeration Date: Jul 23, 2025
Last Updated: Jul 23, 2025

Practice Location

Address: 1315 EMANCIPATION HWY
City: Fredericksburg
State: Virginia
ZIP Code: 22401-4640
Phone: (540) 899-1777

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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