Organization
GA SOUTHERN DENTAL PPO
Active
Parent organization
GA SOUTHERN DENTAL PPO
Other names
Adams Family and Cosmetic Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
GA SOUTHERN DENTAL PPO
Authorized official
ERIKA MENJIVAR (CREDENTIALING MANAGER)
(469) 596-6137
Entity
Organization
Contact information
Practice address
7407 N LAKE LOOP, COLUMBUS, GA 31909-2577
(706) 323-8811
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
12/15/2025
Last updated
12/16/2025
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