Organization · Type 2 NPI

TX Southern Dental Ppo PC

Dentist · Irving, TX

NPI number 1114898780 Active

Practice location

975 W John Carpenter Fwy Ste 115
Irving, TX 75039-2512

Call (972) 556-1172 Map

Mailing address

5830 Granite Pkwy Ste 780
Plano, TX 75024-6775

Specialties and licenses

Taxonomy	Code	License
Dentist Primary	122300000X	None listed

Dentist: A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requiremen…

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NPI record

NPI: 1114898780
Entity type: Organization (Type 2)
Issued: Sep 16, 2025
Last updated: Sep 16, 2025
Status: Active
Subpart: Yes of TX Southern Dental Ppo PC

Other names

Cosmetic Family Dentistry of Las Colinas · doing business as

Authorized official

Erika Melissa Menjivar
Sr. Credentialing Manager
(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 1114898780

TX Southern Dental Ppo PC's National Provider Identifier is 1114898780, issued on Sep 16, 2025. The primary taxonomy on file is Dentist (122300000X), and the practice location is in Irving, TX. The record was last updated on Sep 16, 2025.