NPI age
— years
Enumerated 2025-08-13
● Active Type 2 · Organization
Subpart
Tx Southern Dental Ppo Pc
Tx Southern Dental Ppo Pc is 1 of 9237 dentist organizations in Texas.
Primary specialty
Dentist
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Menjivar
SR. Credentialing Specialist
Last NPPES update
2025-08-13
Source: monthly bulk 2026-05
How this organization compares
Across 9237 active dentist providers in Texas.
NPI age
0 years
↓ 12 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2025 → 2026
2025-08Enumerated in NPPES
2025
2026
Where they practice
Primary practice location
108 S Main St
Buda, TX 786103375
Mailing address
5830 Granite Pkwy Ste 780
Plano, TX 750246775
Authorized official
Erika Melissa Menjivar
SR. Credentialing Specialist
📞 4695966137
Individual providers at this organization
2 individual providers on file at this primary practice address.
- Carol Evans, DDS Dentist NPI 1124056676
- Justin Koen, DMD Dentist NPI 1679651194
Specialties
-
Dentist PrimaryA dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two...
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Main St. Dental
Practice context
Multi-provider organization. 2 individual providers on file at this primary address.
Subpart of Tx Southern Dental Ppo Pc.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.