Tx Southern Dental Ppo PC
NPI #1518772052 in Colleyville, Texas
Provider Information
- NPI Number
- 1518772052
- 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
- Feb 11, 2025
- Last Updated
- Feb 11, 2025
Practice Location
- Address
- 4013 GATEWAY DR
- City
- Colleyville
- State
- Texas
- ZIP Code
- 76034-5917
- Phone
- (817) 369-8007
Authorized Official
- Name
- ERIKA MELISSA MENJIVAR
- Title
- SR. CREDENTIALING SPECIALIST
- Phone
- (469) 596-6137
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
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