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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
Colleyville Family Dental, Oliver Dental & Implants
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
5005 HERITAGE AVE STE 100, COLLEYVILLE, TX 76034-5985
(682) 738-3029
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
01/05/2024
Last updated
03/17/2026
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