=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437003712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TN SOUTHERN DENTAL PPO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2026
-----------------------------------------------------
Last Update Date | 02/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2176 HILLSBORO RD STE 114
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37069-6230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-435-3888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5830 GRANITE PKWY STE 780
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-6775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR. CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | ERIKA MELISSA MENJIVAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-596-6137
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------