NPIMap

Organization Active NPI

DC Southern Dental PPO PC

  • Dentist
  • Washington, DC
National Provider Identifier
1942013222
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DC SOUTHERN DENTAL PPO PC
Doing business as
Georgetown Smile
Practice address
4400 Macarthur Blvd NW Ste 200
Washington, DC 20007-2521
Phone
(202) 333-0003
NPI assigned
Jan 30, 2025
Organization subpart
Yes
Parent organization
DC SOUTHERN DENTAL PPO PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Erika 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

4400 Macarthur Blvd NW Ste 200
Washington, DC 20007-2521

Mailing address

5830 Granite Pkwy Ste 780
Plano, TX 75024-6775

Other names 1

  • Georgetown Smile Doing business as

National Provider Directory

National Provider Directory
Tax ID family
DC Southern Dental PPO PC2 organizations share this tax ID, including this one
Part of
DC Southern Dental PPO PC

Other organizations with this tax ID 1

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

Locations

4400 MacArthur Blvd NW
Ste 200
Washington, DC 20007
Phone (202) 333-0003

Practitioners & affiliated clinicians

Practitioners 1

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": "1738195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738195200000",
    "number": "1942013222",
    "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": "4400 MACARTHUR BLVD NW STE 200",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200072521",
            "telephone_number": "202-333-0003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DC SOUTHERN DENTAL PPO PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DC SOUTHERN DENTAL PPO PC",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-29",
        "status": "A",
        "authorized_official_last_name": "MENJIVAR",
        "authorized_official_first_name": "ERIKA",
        "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": "Georgetown Smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.