OrganizationActive
Tx Southern Dental Ppo PC
NPI 1063300960 · Periodontics · San Antonio, TX
Tx Southern Dental Ppo PC is a Periodontics organization in San Antonio, TX (NPI 1063300960).
Provider details
- NPI number
- 1063300960
- Entity type
- Organization
- Primary specialty
- PeriodonticsDental Providers
- Parent organization
- Tx Southern Dental Ppo PC
- Organization subpart
- Yes
- Authorized official
- Erika Menjivar, Sr. Credentialing Specialist(469) 596-6137
Specialties & taxonomies
Dental Providers
Profile Score
Established profile(54/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4871 Fredericksburg Rd
San Antonio, TX 78229-3627
Phone: (210) 349-5553
Street-level locationGet directions
Mailing address
5830 Granite Pkwy Ste 780
Plano, TX 75024-6775
Other names (DBA / former)
- Doing business as
- Ricardo Diaz DDS
Registry dates
- Enumerated
- 2025-06-27
- Last updated
- 2025-06-27
- Certified
- 2025-06-27
Frequently asked questions
- What is Tx Southern Dental Ppo PC's NPI number?
- Tx Southern Dental Ppo PC's National Provider Identifier (NPI) is 1063300960, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Tx Southern Dental Ppo PC?
- Tx Southern Dental Ppo PC is classified in the NPPES registry as Periodontics (Dental Providers).
- Where is Tx Southern Dental Ppo PC located?
- Tx Southern Dental Ppo PC's practice location on file with NPPES is 4871 Fredericksburg Rd, San Antonio, TX 78229-3627.
- What is Tx Southern Dental Ppo PC's phone number?
- The practice phone number listed in the NPPES registry for Tx Southern Dental Ppo PC is (210) 349-5553.
- Who is the authorized official for Tx Southern Dental Ppo PC?
- The authorized official listed on Tx Southern Dental Ppo PC's NPPES record is Erika Menjivar, Sr. Credentialing Specialist. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Tx Southern Dental Ppo PC's NPI active?
- Yes — Tx Southern Dental Ppo PC's NPI (1063300960) is active in the NPPES registry as of the last update on 2025-06-27.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.