NPIMap

Organization Active NPI

TN Southern Dental PPO

  • Dentist
  • Chattanooga, TN
National Provider Identifier
1306672191
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
TN SOUTHERN DENTAL PPO
Practice address
1001 Carter St
Chattanooga, TN 37402-5014
Phone
(423) 266-0722
NPI assigned
Sep 10, 2024
Organization subpart
Yes
Parent organization
TN SOUTHERN DENTAL PPOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

1001 Carter St
Chattanooga, TN 37402-5014

Mailing address

5830 Granite Pkwy Ste 780
Plano, TX 75024-6775
Phone (469) 596-6137

Other names 1

  • Frank Trundle DDS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
TN Southern Dental PPO6 organizations share this tax ID, including this one
Part of
TN Southern Dental PPO

Other organizations with this tax ID 5

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

Locations

1001 Carter St
Chattanooga, TN 37402
Phone (423) 266-0722

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1306672191",
    "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",
            "telephone_number": "469-596-6137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 CARTER ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374025014",
            "telephone_number": "423-266-0722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TN SOUTHERN DENTAL PPO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TN SOUTHERN DENTAL PPO",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "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": "Frank Trundle DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; 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.