Tx Southern Dental Ppo PC

NPI #1114898780 in Irving, Texas

Provider Information

NPI Number: 1114898780
Entity Type: Organization
Organization Name: Tx Southern Dental Ppo PC
Subpart: Yes (part of a larger organization)
Parent Organization: TX SOUTHERN DENTAL PPO PC
Primary Specialty: Dentist
Enumeration Date: Sep 16, 2025
Last Updated: Sep 16, 2025

Practice Location

Address: 975 W JOHN CARPENTER FWY STE 115
City: Irving
State: Texas
ZIP Code: 75039-2512
Phone: (972) 556-1172

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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