Organization · Type 2 NPI

Ga Southern Dental LLC

Dentist · Macon, GA

NPI number 1053139519 Active

Practice location

3298 Northside Dr
Macon, GA 31210-2553

Call (478) 475-1976 Map

Mailing address

5830 Granite Pkwy Ste 780
Plano, TX 75024-6775

Specialties and licenses

Taxonomy	Code	License
Dentist Primary	122300000X	None listed

Dentist: 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 requiremen…

2 other providers at this address

Other dentist providers in Macon

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NPI record

NPI: 1053139519
Entity type: Organization (Type 2)
Issued: Oct 2, 2024
Last updated: Oct 2, 2024
Status: Active
Subpart: Yes of Ga Southern Dental LLC

Other names

Northside Dentistry · doing business as

Authorized official

Erika Melissa Menjivar
Sr. Credentialing Specialist
(469) 596-6137

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1053139519

Ga Southern Dental LLC's National Provider Identifier is 1053139519, issued on Oct 2, 2024. The primary taxonomy on file is Dentist (122300000X), and the practice location is in Macon, GA. The record was last updated on Oct 2, 2024.