Ga Southern Dental LLC

NPI #1053139519 in Macon, Georgia

Provider Information

NPI Number: 1053139519
Entity Type: Organization
Organization Name: Ga Southern Dental LLC
Subpart: Yes (part of a larger organization)
Parent Organization: GA SOUTHERN DENTAL LLC
Primary Specialty: Dentist
Enumeration Date: Oct 2, 2024
Last Updated: Oct 2, 2024

Practice Location

Address: 3298 NORTHSIDE DR
City: Macon
State: Georgia
ZIP Code: 31210-2553
Phone: (478) 475-1976

Authorized Official

Name: ERIKA MELISSA MENJIVAR
Title: SR. CREDENTIALING SPECIALIST
Phone: (469) 596-6137

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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