NPIMap

Organization Active NPI

Hill Southern Dental of Maryland PPO PC

  • Dentist
  • Baltimore, MD
National Provider Identifier
1780480640
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
HILL SOUTHERN DENTAL OF MARYLAND PPO PC
Practice address
11600 Crossroads Cir Ste a
Baltimore, MD 21220-2869
Phone
(410) 931-7133
NPI assigned
Feb 21, 2025
Organization subpart
Yes
Parent organization
HILL SOUTHERN DENTAL OF MARYLAND PPO PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 21, 2025

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

11600 Crossroads Cir Ste a
Baltimore, MD 21220-2869

Mailing address

5830 Granite Pkwy Ste 780
Plano, TX 75024-6775

Other names 1

  • White Marsh Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hill Southern Dental of Maryland PPO PC9 organizations share this tax ID, including this one
Part of
Hill Southern Dental of Maryland PPO PC

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1740096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740096000000",
    "number": "1780480640",
    "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": "11600 CROSSROADS CIR STE A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212202869",
            "telephone_number": "410-931-7133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILL SOUTHERN DENTAL OF MARYLAND PPO PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HILL SOUTHERN DENTAL OF MARYLAND PPO PC",
        "enumeration_date": "2025-02-21",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "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": "White Marsh Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.