VA Southern Dental PPO PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

VA SOUTHERN DENTAL PPO PC

Practice address

1315 Emancipation Hwy
Fredericksburg, VA 22401-4640

Phone

(540) 899-1777

NPI assigned

Jul 23, 2025

Organization subpart

Yes

Parent organization

VA SOUTHERN DENTAL PPO PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Erika Melissa Menjivar

Title

Sr. Credentialing Specialist

Phone

(469) 596-6137

Specialties & licenses 1

Addresses

Other names 1

• Big Smile Dental Doing business as

Tax ID family

VA Southern Dental PPO PC2 organizations share this tax ID, including this one

Part of

VA Southern Dental PPO PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• VA Southern Dental PPO PC

  • Dentist
  • Annandale, VA
  • NPI 1508718750
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753228800000",
    "number": "1053293746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5830 GRANITE PKWY STE 780",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750246775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 EMANCIPATION HWY",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014640",
            "telephone_number": "540-899-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VA SOUTHERN DENTAL PPO PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VA SOUTHERN DENTAL PPO PC",
        "enumeration_date": "2025-07-23",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A",
        "authorized_official_last_name": "MENJIVAR",
        "authorized_official_first_name": "ERIKA",
        "authorized_official_middle_name": "MELISSA",
        "authorized_official_title_or_position": "SR. CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "469-596-6137"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Big Smile Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sunitha S Urs, M.D
• US Orthotics & Prosthetics, Inc.
• Usv Optical Inc.
• Beverly Uzoho, LCSW
• VA Smiles Dental Center PLLC
• VA-I Medical Services PC
• Brooke Vaillancourt
• Valdivia Dental LLC
• Megan Marie Valentine, BCBA, LBA
• Marisa Valero, LPC

• Dentist in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.