TX SOUTHERN DENTAL PPO PC
NPI 1063300960
Dentist - Periodontics in San Antonio, TX

Q: What is Tx Southern Dental Ppo PC's NPI number?

The NPI number for Tx Southern Dental Ppo PC is 1063300960. It was assigned to this organization in the NPPES registry on June 27, 2025. The provider is doing business as Ricardo Diaz DDS.

Q: What is Tx Southern Dental Ppo PC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Active since June 27, 2025

4871 FREDERICKSBURG RD, SAN ANTONIO, TX 78229(210) 349-5553 Get Directions Write a Review

NPPES record last updated: June 27, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Tx Southern Dental Ppo Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TX SOUTHERN DENTAL PPO PC (NPI 1063300960), doing business as Ricardo Diaz Dds, is a healthcare organization registered as a periodontics in San Antonio, Texas and active in the NPI registry since June 2025. The organization lists Erika Melissa Menjivar, Sr. Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1063300960

Entity TypeOrganization

Primary Taxonomy1223P0300X

Legal Business NameTX SOUTHERN DENTAL PPO PC

Location Address4871 FREDERICKSBURG RDSan Antonio, TX 78229-3627

Mailing Address5830 Granite Pkwy Ste 780Plano, TX 75024-6775

Phone(210) 349-5553

Organization SubpartYes

Authorized OfficialErika Melissa MenjivarSr. Credentialing Specialist · (469) 596-6137

Enumeration DateJune 27, 2025

NPPES CertifiedJune 27, 2025

✔ NPI 1063300960 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers

Taxonomy Code1223P0300X

Definition

That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

4871 FREDERICKSBURG RD, San Antonio, TX 78229

Open in Google Maps ↗

Other Names 1

Doing Business AsRicardo Diaz Dds

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. RICARDO DIAZ DDS, MS

Dentist (Periodontics)

4871 FREDERICKSBURG RD
SAN ANTONIO, TX 78229

Bexar County (210) 349-5553

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tx Southern Dental Ppo PC's NPI number?

The NPI number for Tx Southern Dental Ppo PC is 1063300960. It was assigned to this organization in the NPPES registry on June 27, 2025. The provider is doing business as Ricardo Diaz DDS.

Where is Tx Southern Dental Ppo PC located?

Tx Southern Dental Ppo PC is located at 4871 Fredericksburg Rd, San Antonio, TX 78229. The listed phone number is (210) 349-5553.

What is Tx Southern Dental Ppo PC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

When was this NPI record last updated?

The NPPES record for Tx Southern Dental Ppo PC was last updated on June 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.