1. Home
  2. Directory
  3. Florida
  4. Lake Mary
  5. Dentist
  6. NPI Profile

FL SOUTHERN DENTAL PPO PA
NPI 1841096799
Dentist in Lake Mary, FL

Active since February 21, 2025
4106 W LAKE MARY BLVD STE 230, LAKE MARY, FL 32746(407) 333-0881 Get Directions Write a Review

NPPES record last updated: February 21, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Fl Southern Dental Ppo Pa NPPES

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

FL SOUTHERN DENTAL PPO PA (NPI 1841096799), doing business as Dental Lake Mary, is a healthcare organization registered as a dentist in Lake Mary, Florida and active in the NPI registry since February 2025. The organization lists Erika Melissa Menjivar, Sr. Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1841096799
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameFL SOUTHERN DENTAL PPO PA
Location Address4106 W LAKE MARY BLVD STE 230Lake Mary, FL 32746-2403
Mailing Address5830 Granite Pkwy Ste 780Plano, TX 75024-6775
Phone(407) 333-0881
Organization SubpartYes
Authorized OfficialErika Melissa MenjivarSr. Credentialing Specialist · (469) 596-6137
Enumeration DateFebruary 21, 2025
NPPES CertifiedFebruary 21, 2025
✔ NPI 1841096799 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
Definition
A 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 degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
4106 W LAKE MARY BLVD STE 230, Lake Mary, FL 32746
Open in Google Maps ↗

Other Names 1

Doing Business AsDental Lake Mary

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter of Alabama.Insurance ›

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. EFFIE C YAO D.D.S.
Dentist
4106 W LAKE MARY BLVD STE 230
LAKE MARY, FL 32746
Seminole County (407) 333-0881

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 Ppo PA's NPI number?

The NPI number for Fl Southern Dental Ppo PA is 1841096799. It was assigned to this organization in the NPPES registry on February 21, 2025. The provider is doing business as Dental Lake Mary.

Where is Fl Southern Dental Ppo PA located?

Fl Southern Dental Ppo PA is located at 4106 W Lake Mary Blvd Ste 230, Lake Mary, FL 32746. The listed phone number is (407) 333-0881.

What is Fl Southern Dental Ppo PA's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

What insurance does Fl Southern Dental Ppo PA accept?

Health plans from Ambetter Health and Ambetter of Alabama list Fl Southern Dental Ppo PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Fl Southern Dental Ppo PA was last updated on February 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.