Organization
DC SOUTHERN DENTAL PPO PC
Active
Parent organization
DC SOUTHERN DENTAL PPO PC
Other names
Georgetown Smile
Organization subpart
Yes
Provider details
NPI number
Legal business name
DC SOUTHERN DENTAL PPO PC
Authorized official
ERIKA MENJIVAR (SR. CREDENTIALING SPECIALIST)
(469) 596-6137
Entity
Organization
Contact information
Practice address
4400 MACARTHUR BLVD NW STE 200, WASHINGTON, DC 20007-2521
(202) 333-0003
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
01/30/2025
Last updated
01/30/2025
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