NPIMap

Organization Active NPI

FL Southern Dental PPO PA

  • Dentist
  • Davie, FL
National Provider Identifier
1124817754
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
FL SOUTHERN DENTAL PPO PA
Practice address
4745 SW 148TH Ave
Davie, FL 33330-2126
Phone
(954) 349-3449
NPI assigned
May 1, 2025
Organization subpart
Yes
Parent organization
FL SOUTHERN DENTAL PPO PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

4745 SW 148TH Ave
Davie, FL 33330-2126

Mailing address

5830 Granite Pkwy Ste 780
Plano, TX 75024-6775

Other names 1

  • Davie Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
FL Southern Dental PPO PA10 organizations share this tax ID, including this one
Part of
FL Southern Dental PPO PA

Other organizations with this tax ID 9

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

Locations

4745 SW 148th Ave
Davie, FL 33330
Phone (954) 349-3449

NPI Registry JSON

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

{
    "created_epoch": "1746057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746057600000",
    "number": "1124817754",
    "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": "4745 SW 148TH AVE",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333302126",
            "telephone_number": "954-349-3449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FL SOUTHERN DENTAL PPO PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FL SOUTHERN DENTAL PPO PA",
        "enumeration_date": "2025-05-01",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "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": "Davie Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.