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GA SOUTHERN DENTAL LLC
NPI 1053139519
Dentist in Macon, GA

Active since October 02, 2024
3298 NORTHSIDE DR, MACON, GA 31210(478) 475-1976 Get Directions Write a Review

NPPES record last updated: October 2, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ga Southern Dental Llc NPPES

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

GA SOUTHERN DENTAL LLC (NPI 1053139519), doing business as Northside Dentistry, is a healthcare organization registered as a dentist in Macon, Georgia and active in the NPI registry since October 2024. The organization lists Erika Melissa Menjivar, Sr. Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1053139519
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameGA SOUTHERN DENTAL LLC
Location Address3298 NORTHSIDE DRMacon, GA 31210-2553
Mailing Address5830 Granite Pkwy Ste 780Plano, TX 75024-6775
Phone(478) 475-1976
Organization SubpartYes
Authorized OfficialErika Melissa MenjivarSr. Credentialing Specialist · (469) 596-6137
Enumeration DateOctober 2, 2024
NPPES CertifiedOctober 2, 2024
✔ NPI 1053139519 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.
3298 NORTHSIDE DR, Macon, GA 31210
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Other Names 1

Doing Business AsNorthside Dentistry

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

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NICOLE LEWIS JACKSON DDS
Dentist
3298 NORTHSIDE DR
MACON, GA 31210
Bibb County (478) 475-1976
NORTHSIDE FAMILY DENTISTRY
Dentist
3298 NORTHSIDE DR
MACON, GA 31210
Bibb County (478) 475-1976

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 Ga Southern Dental LLC's NPI number?

The NPI number for Ga Southern Dental LLC is 1053139519. It was assigned to this organization in the NPPES registry on October 2, 2024. The provider is doing business as Northside Dentistry.

Where is Ga Southern Dental LLC located?

Ga Southern Dental LLC is located at 3298 Northside Dr, Macon, GA 31210. The listed phone number is (478) 475-1976.

What is Ga Southern Dental LLC's specialty?

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

When was this NPI record last updated?

The NPPES record for Ga Southern Dental LLC was last updated on October 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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.