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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
Rossen Dental, The Colony Family Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
TX SOUTHERN DENTAL PPO PC
Authorized official
ERIKA MELISSA MENJIVAR (SR. CREDENTIALING SPECIALIST)
(469) 596-6137
Entity
Organization
Contact information
Practice address
5204 S COLONY BLVD STE 150, THE COLONY, TX 75056-2390
(469) 656-7265
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
(469) 450-6482
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/28/2023
Last updated
03/17/2026
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