Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tx Southern Dental PPO PC

Organization Periodontics · NPI 1063300960

Tx Southern Dental PPO PC is a Periodontics in San Antonio, Texas. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

4871 Fredericksburg Rd
San Antonio, TX 78229-3627
Phone: (210) 349-5553
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Periodontics (primary) Taxonomy 1223P0300X

Record details

NPI number1063300960
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationTx Southern Dental PPO PC
Authorized official Erika Menjivar — Sr. Credentialing Specialist · (469) 596-6137
Other names Ricardo Diaz Dds
NPI enumeratedJune 27, 2025
Last updated in NPPESJune 27, 2025
Certification dateJune 27, 2025
Mailing address5830 Granite Pkwy Ste 780, Plano, TX 75024-6775

Other providers in San Antonio