Organization
TN SOUTHERN DENTAL PPO
Active
Parent organization
TN SOUTHERN DENTAL PPO
Other names
Green Dental Health and Aesthetics
Organization subpart
Yes
Provider details
NPI number
Legal business name
TN SOUTHERN DENTAL PPO
Authorized official
ERIKA MELISSA MENJIVAR (SR. CREDENTIALING SPECIALIST)
(469) 596-6137
Entity
Organization
Contact information
Practice address
2000 RICHARD JONES RD STE 166, NASHVILLE, TN 37215-2885
(615) 383-8213
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
02/21/2025
Last updated
02/21/2025
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