Organization · Type 2 NPI

TX Southern Dental Ppo PC

Dentist · Colleyville, TX

NPI number 1831969302 Active

Practice location

5005 Heritage Ave Ste 100
Colleyville, TX 76034-5985

Call (682) 738-3029 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: 1831969302
Entity type: Organization (Type 2)
Issued: Jan 5, 2024
Last updated: Mar 17, 2026
Status: Active
Subpart: Yes of TX Southern Dental Ppo PC

Other names

Colleyville Family Dental · 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 1831969302

TX Southern Dental Ppo PC's National Provider Identifier is 1831969302, issued on Jan 5, 2024. The primary taxonomy on file is Dentist (122300000X), and the practice location is in Colleyville, TX. The record was last updated on Mar 17, 2026.