# GA SOUTHERN DENTAL PPO

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GA SOUTHERN DENTAL PPO
- **Other names:** Adams Family and Cosmetic Dentistry
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1215891049
- **Legal business name:** GA SOUTHERN DENTAL PPO
- **Authorized official:** ERIKA MENJIVAR (CREDENTIALING MANAGER)
- **Authorized official phone:** (469) 596-6137

## Contact information

- **Practice address:** 7407 N LAKE LOOP, COLUMBUS, GA 31909-2577
- **Practice address phone:** (706) 323-8811
- **Mailing address:** 5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 12/15/2025
- **Last updated:** 12/16/2025