Tx Southern Dental Ppo PC

NPI #1780572685 in Dripping Springs, Texas

Provider Information

NPI Number
1780572685
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
Jun 27, 2025
Last Updated
Aug 27, 2025

Practice Location

Address
27490 RANCH ROAD 12 # 108
State
Texas
ZIP Code
78620-4993
Phone
(512) 858-9250

Authorized Official

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

Specialties & Taxonomy Codes

Specialty
Dentist

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Organizations

Provider Name
Tx Southern Dental Ppo PC

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