Tx Southern Dental Ppo PC
NPI #1407682511 in League City, Texas
Provider Information
- NPI Number
- 1407682511
- 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 13, 2024
- Last Updated
- Sep 25, 2024
Practice Location
- Address
- 6011 W MAIN ST STE A101
- City
- League City
- State
- Texas
- ZIP Code
- 77573-7541
- Phone
- (281) 338-6559
Authorized Official
- Name
- ERIKA MELISSA MENJIVAR
- Title
- SR. CREDENTIALING SPECIALIST
- Phone
- (469) 596-6137
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
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