Tx Southern Dental PPO PC
NPI 1407682511ActiveOrganization· Dentist· League City, TX
Dentist in League City, Texas, registered in NPPES in September 2024, part of Tx Southern Dental PPO PC. The authorized official on file is Erika Melissa Menjivar, Sr. Credentialing Specialist.
Overview
| NPI | 1407682511 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Tx Southern Dental PPO PC |
| NPI issued | Sep 13, 2024 |
| Last updated in NPPES | Sep 25, 2024 |
| Certified by provider | Sep 25, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other Dentist providers in League City
- 1043430382
- 1740200070
- 1154875896
- 1487256392
- 1326592601
- 1265899272
- 1811473804
- 1952714990
- 1851849111
- 1821469255
- 1306616818
- 1821228875