| Tx Southern Dental Ppo Pc | |
|
750 Fish Creek Thoroughfare Ste 260 Montgomery TX 77316-6966 | |
| (936) 289-9353 | |
| Not Available |
| Full Name | Tx Southern Dental Ppo Pc |
|---|---|
| Speciality | Dentist |
| Location | 750 Fish Creek Thoroughfare Ste 260, Montgomery, Texas |
| 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 |
|---|---|
| Tx Southern Dental Ppo Pc 5830 Granite Pkwy Ste 780 Plano TX 75024-6775 Ph: () - | Tx Southern Dental Ppo Pc 750 Fish Creek Thoroughfare Ste 260 Montgomery TX 77316-6966 Ph: (936) 289-9353 |
| NPI Number | 1013857598 |
|---|---|
| Provider Enumeration Date | 04/01/2026 |
| Last Update Date | 04/01/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013857598 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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