Fl Southern Dental Ppo PA

NPI #1124817754 in Davie, Florida

Provider Information

NPI Number: 1124817754
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: May 1, 2025
Last Updated: May 1, 2025

Practice Location

Address: 4745 SW 148TH AVE
City: Davie
State: Florida
ZIP Code: 33330-2126
Phone: (954) 349-3449

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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