Organization · Type 2 NPI

TX Southern Dental Ppo PC

Periodontics · San Antonio, TX

NPI number 1063300960 Active

Practice location

4871 Fredericksburg Rd
San Antonio, TX 78229-3627

Call (210) 349-5553 Map

Mailing address

5830 Granite Pkwy Ste 780
Plano, TX 75024-6775

Specialties and licenses

Taxonomy	Code	License
Periodontics Primary	1223P0300X	None listed

Periodontics: That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

Another provider at this address

Ricardo Diaz, DDS, MSPeriodontics San Antonio, TX NPI 1538259254

Other periodontics providers in San Antonio

See all in San Antonio →

NPI record

NPI: 1063300960
Entity type: Organization (Type 2)
Issued: Jun 27, 2025
Last updated: Jun 27, 2025
Status: Active
Subpart: Yes of TX Southern Dental Ppo PC

Other names

Ricardo Diaz DDS · doing business as

Authorized official

Erika Melissa Menjivar
Sr. Credentialing Specialist
(469) 596-6137

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1063300960

TX Southern Dental Ppo PC's National Provider Identifier is 1063300960, issued on Jun 27, 2025. The primary taxonomy on file is Periodontics (1223P0300X), and the practice location is in San Antonio, TX. The record was last updated on Jun 27, 2025.