| Fl Southern Dental Ppo Pa | |
|
4745 Sw 148th Ave Davie FL 33330-2126 | |
| (954) 349-3449 | |
| Not Available |
| Full Name | Fl Southern Dental Ppo Pa |
|---|---|
| Speciality | Dentist |
| Location | 4745 Sw 148th Ave, Davie, Florida |
| Authorized Official Name and Position | Erika Melissa Menjivar (SR. CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4695966137 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fl Southern Dental Ppo Pa 5830 Granite Pkwy Ste 780 Plano TX 75024-6775 Ph: () - | Fl Southern Dental Ppo Pa 4745 Sw 148th Ave Davie FL 33330-2126 Ph: (954) 349-3449 |
| NPI Number | 1124817754 |
|---|---|
| Provider Enumeration Date | 05/01/2025 |
| Last Update Date | 05/01/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124817754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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