Organization
FL SOUTHERN DENTAL PPO PA
Active
Parent organization
FL SOUTHERN DENTAL PPO PA
Other names
Aventura Dental of Excellence
Organization subpart
Yes
Provider details
NPI number
Legal business name
FL SOUTHERN DENTAL PPO PA
Authorized official
ERIKA MELISSA MENJIVAR (SR. CREDENTIALING SPECIALIST)
(469) 596-6137
Entity
Organization
Contact information
Practice address
21355 E DIXIE HWY STE 105, AVENTURA, FL 33180-1239
(305) 935-3157
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
02/11/2025
Last updated
02/11/2025
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