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Organization
TX SOUTHERN DENTAL PPO PC
Active
Organization
TX SOUTHERN DENTAL PPO PC
Active
Other names
Bluebonnet Oral Surgery & Implants
Organization subpart
No
Provider details
NPI number
Authorized official
ERIKA MELISSA MENJIVAR (SR. CREDENTIALING SPECIALIST)
(469) 596-6137
Entity
Organization
Contact information
Practice address
7300 BLANCO RD STE 100, SAN ANTONIO, TX 78216-4937
(210) 344-9898
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
(469) 596-6137
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
06/25/2024
Last updated
06/25/2024
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