Active NPI
TX Southern Dental PPO PC
- Dentist
- San Antonio, TX
National Provider Identifier
1336056233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Legal business name
- TX SOUTHERN DENTAL PPO PC
- Practice address
- 4807 Fredericksburg Rd
San Antonio, TX 78229-3627 - Phone
- (210) 341-3181
- NPI assigned
- Aug 26, 2026
- Organization subpart
- Yes
- Parent organization
- TX SOUTHERN DENTAL PPO PC
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | Primary |
Addresses
Primary practice location
4807 Fredericksburg Rd
San Antonio, TX 78229-3627
Mailing address
5830 Granite Pkwy Ste 780
Plano, TX 75024-6775
Other names 1
- Michael Miller DDS
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1787702400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1787702400000",
"number": "1336056233",
"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": "4807 FREDERICKSBURG RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782293627",
"telephone_number": "210-341-3181"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TX SOUTHERN DENTAL PPO PC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TX SOUTHERN DENTAL PPO PC",
"enumeration_date": "2026-08-26",
"last_updated": "2026-08-26",
"certification_date": "2026-08-26",
"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": "Michael Miller DDS",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.