NPIMap

Organization Active NPI

TX Southern Dental PPO PC

Doing business as Mark Gray DDS

  • Dentist
  • Houston, TX
National Provider Identifier
1588494173
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
TX SOUTHERN DENTAL PPO PC
Doing business as
Mark Gray DDS
Practice address
1127 Eldridge Pkwy Ste 1040
Houston, TX 77077-1773
Phone
(281) 862-3559
NPI assigned
Aug 7, 2024
Last updated
Aug 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TX SOUTHERN DENTAL PPO PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 7, 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
Dentist 122300000X NU Primary

Addresses

Primary practice location

1127 Eldridge Pkwy Ste 1040
Houston, TX 77077-1773

Mailing address

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

Other names 1

  • Mark Gray DDS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
TX Southern Dental PPO PC44 organizations share this tax ID, including this one
Part of
TX Southern Dental PPO PC

Other organizations with this tax ID 43

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

View all 43

Locations

1127 Eldridge Pkwy
Ste 1040
Houston, TX 77077
Phone (281) 493-9395

NPI Registry JSON

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

{
    "created_epoch": "1722988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1588494173",
    "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": "1127 ELDRIDGE PKWY STE 1040",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770771773",
            "telephone_number": "281-862-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TX SOUTHERN DENTAL PPO PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TX SOUTHERN DENTAL PPO PC",
        "enumeration_date": "2024-08-07",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "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": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mark Gray DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.