FL Southern Dental PA

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

FL SOUTHERN DENTAL PA

Practice address

382 N Causeway
New Smyrna Beach, FL 32169-5233

Phone

(386) 428-6468

NPI assigned

Jul 16, 2025

Organization subpart

Yes

Parent organization

FL SOUTHERN DENTAL PAAs 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

• Mckenzie Dental Group Doing business as

Tax ID family

FL Southern Dental PA2 organizations share this tax ID, including this one

Part of

FL Southern Dental PA

Other organizations with this tax ID 1

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

• FL Southern Dental PA

  • General Practice Dentistry
  • St Augustine, FL
  • NPI 1265133185
  NPD tax ID

Locations

Practitioners 1

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

• James David McKenzie, DDS

  • General Practice Dentistry
  • New Smyrna Beach, FL
  • NPI 1588877542
  NPD (past)

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

{
    "created_epoch": "1752624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1720970569",
    "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": "382 N CAUSEWAY",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321695233",
            "telephone_number": "386-428-6468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FL SOUTHERN DENTAL PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FL SOUTHERN DENTAL PA",
        "enumeration_date": "2025-07-16",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "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": "Mckenzie Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Richard Dinis Ferrer Jr.
• Daviana Figueroa
• First Choice Supports Inc.
• Tina Fischer-Carne, MD
• Elizabeth Kern Fisher, MA, CCC-SLP
• Hugh Jacob Flanagan, PHARM.D.
• Frank Flasterstein, MD PA
• Dorie Fleming
• Florida Cancer Specialists P L
• Florida Eye Clinic P.a.

• Dentist in New Smyrna Beach, FL
• Providers in New Smyrna Beach, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.