FL SOUTHERN DENTAL PA
NPI 1265133185
Dentist - General Practice in St Augustine, FL

Q: What is Fl Southern Dental PA's NPI number?

The NPI number for Fl Southern Dental PA is 1265133185. It was assigned to this organization in the NPPES registry on March 16, 2023. The provider is doing business as Matanzas Dental Group.

Q: What is Fl Southern Dental PA's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since March 16, 2023

100 WHETSTONE PL STE 308, ST AUGUSTINE, FL 32086(904) 810-2345 Get Directions Write a Review

NPPES record last updated: March 17, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Mar 17, 2026, Mar 16, 2023 (2 updates tracked since 2023).

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About Fl Southern Dental Pa NPPES

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

FL SOUTHERN DENTAL PA (NPI 1265133185), doing business as Matanzas Dental Group, is a healthcare organization registered as a general practice in St Augustine, Florida and active in the NPI registry since March 2023. The organization lists Erika Melissa Menjivar, Sr. Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1265133185

Entity TypeOrganization

Primary Taxonomy1223G0001X

Legal Business NameFL SOUTHERN DENTAL PA

Location Address100 WHETSTONE PL STE 308St Augustine, FL 32086-5775

Mailing Address5830 Granite Pkwy Ste 780Plano, TX 75024-6775 · (469) 596-6011

Phone(904) 810-2345

Organization SubpartYes

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

Enumeration DateMarch 16, 2023

Last NPPES UpdateMarch 17, 20262 updates tracked since enumeration

NPPES CertifiedMarch 17, 2026

✔ NPI 1265133185 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

100 WHETSTONE PL STE 308, St Augustine, FL 32086

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Other Names 1

Doing Business AsMatanzas Dental Group

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. ALISON MARIE CARUSO DDS

Dentist (General Practice)

100 WHETSTONE PL STE 308
ST AUGUSTINE, FL 32086

St. Johns County (904) 299-7997

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 Fl Southern Dental PA's NPI number?

The NPI number for Fl Southern Dental PA is 1265133185. It was assigned to this organization in the NPPES registry on March 16, 2023. The provider is doing business as Matanzas Dental Group.

Where is Fl Southern Dental PA located?

Fl Southern Dental PA is located at 100 Whetstone Pl Ste 308, St Augustine, FL 32086. The listed phone number is (904) 810-2345.

What is Fl Southern Dental PA's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Fl Southern Dental PA was last updated on March 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.