Organization
FL SOUTHERN DENTAL PA
Active
Parent organization
FL SOUTHERN DENTAL PA
Other names
Matanzas Dental Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
FL SOUTHERN DENTAL PA
Authorized official
ERIKA MELISSA MENJIVAR (SR. CREDENTIALING SPECIALIST)
(469) 596-6137
Entity
Organization
Contact information
Practice address
100 WHETSTONE PL STE 308, ST AUGUSTINE, FL 32086-5775
(904) 810-2345
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
(469) 596-6011
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/16/2023
Last updated
03/17/2026
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