Tx Southern Dental Ppo PC

NPI #1821974056 in Austin, Texas

Provider Information

NPI Number: 1821974056
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: Aug 13, 2025
Last Updated: Aug 13, 2025

Practice Location

Address: 3624 N HILLS DR STE A103
City: Austin
State: Texas
ZIP Code: 78731-3061
Phone: (512) 346-3631

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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