Organization · Type 2 NPI

FL Southern Dental Ppo PA

Dentist · Tampa, FL

NPI number 1275473704 Active

Practice location

3910 Northdale Blvd Ste 102A
Tampa, FL 33624-1800

Call (813) 969-0294 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: 1275473704
Entity type: Organization (Type 2)
Issued: Apr 1, 2026
Last updated: Apr 1, 2026
Status: Active
Subpart: Yes of FL Southern Dental Ppo PA

Other names

Northdale-Dental Health Services · 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 1275473704

FL Southern Dental Ppo PA's National Provider Identifier is 1275473704, issued on Apr 1, 2026. The primary taxonomy on file is Dentist (122300000X), and the practice location is in Tampa, FL. The record was last updated on Apr 1, 2026.