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Organization
TX SOUTHERN DENTAL PPO PC
Active
Organization
TX SOUTHERN DENTAL PPO PC
Active
Parent organization
TX SOUTHERN DENTAL PPO PC
Other names
Cosmetic Family Dentistry of Las Colinas
Organization subpart
Yes
Provider details
NPI number
Legal business name
TX SOUTHERN DENTAL PPO PC
Authorized official
ERIKA MELISSA MENJIVAR (SR. CREDENTIALING MANAGER)
(469) 596-6137
Entity
Organization
Contact information
Practice address
975 W JOHN CARPENTER FWY STE 115, IRVING, TX 75039-2512
(972) 556-1172
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
09/16/2025
Last updated
09/16/2025
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