VA Southern Dental PPO PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

VA SOUTHERN DENTAL PPO PC

Practice address

4330 Evergreen LN Ste F1
Annandale, VA 22003-3258

Phone

(703) 941-2763

NPI assigned

Feb 11, 2026

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

• Yen Le DDS 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
  • Fredericksburg, VA
  • NPI 1053293746
  NPD tax ID

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

{
    "created_epoch": "1770768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770768000000",
    "number": "1508718750",
    "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": "4330 EVERGREEN LN STE F1",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220033258",
            "telephone_number": "703-941-2763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VA SOUTHERN DENTAL PPO PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VA SOUTHERN DENTAL PPO PC",
        "enumeration_date": "2026-02-11",
        "last_updated": "2026-02-11",
        "certification_date": "2026-02-11",
        "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": "Yen Le DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Prasann Vachhani, MD
• Aura Valdez Perez
• Ana Maria Valeriano Cruz
• Hendrika Vande Kemp, PHD
• Ellen Clarke Vaughey, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2026; 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.