Organization · Type 2 NPI

FL Southern Dental PA

General Practice Dentistry · St. Augustine, FL

NPI number 1265133185 Active

Practice location

100 Whetstone Pl Ste 308
St. Augustine, FL 32086-5775

Call (904) 810-2345 Map

Mailing address

5830 Granite Pkwy Ste 780
Plano, TX 75024-6775

Specialties and licenses

Taxonomy	Code	License
General Practice Dentistry Primary	1223G0001X	None listed

General Practice Dentistry: A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Another provider at this address

Alison Marie Caruso, DDSGeneral Practice Dentistry St. Augustine, FL NPI 1952804767

Other general practice dentistry providers in St. Augustine

See all in St. Augustine →

NPI record

NPI: 1265133185
Entity type: Organization (Type 2)
Issued: Mar 16, 2023
Last updated: Mar 17, 2026
Status: Active
Subpart: Yes of FL Southern Dental PA

Other names

Matanzas Dental Group · 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 1265133185

FL Southern Dental PA's National Provider Identifier is 1265133185, issued on Mar 16, 2023. The primary taxonomy on file is General Practice Dentistry (1223G0001X), and the practice location is in St. Augustine, FL. The record was last updated on Mar 17, 2026.