MEDICARE: HILL SOUTHERN DENTAL OF MARYLAND PPO PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1902788730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILL SOUTHERN DENTAL OF MARYLAND PPO PC

Provider Business Mailing Address
First Line	:	5830 GRANITE PKWY STE 780
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-6775
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 CHESAPEAKE AVE
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-3132
Country	:	US
Telephone Number	:	410-268-8701
Fax Number	:

Authorized Official
Title or Position	:	SR. CREDENTIALING SPECIALIST
Name	:	ERIKA MELISSA MENJIVAR
Credential	:
Telephone Number	:	469-596-6137

Provider Enumeration Date	:	07/23/2025
Last Update Date	:	07/23/2025

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Directions to “HILL SOUTHERN DENTAL OF MARYLAND PPO PC ” Practice Location

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