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GA SOUTHERN DENTAL PPO
NPI 1417783291
Dentist in Suwanee, GA

Active since September 10, 2024
1000 PEACHTREE INDUSTRIAL BLVD STE 10, SUWANEE, GA 30024(770) 614-4666 Get Directions Write a Review

NPPES record last updated: March 17, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 17, 2026, Sep 10, 2024 (2 updates tracked since 2024).

About Ga Southern Dental Ppo NPPES

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

GA SOUTHERN DENTAL PPO (NPI 1417783291), doing business as Suwanee Creek Dentistry, is a healthcare organization registered as a dentist in Suwanee, Georgia and active in the NPI registry since September 2024. The organization lists Erika Melissa Menjivar, Sr. Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1417783291
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameGA SOUTHERN DENTAL PPO
Location Address1000 PEACHTREE INDUSTRIAL BLVD STE 10Suwanee, GA 30024-1977
Mailing Address5830 Granite Pkwy Ste 780Plano, TX 75024-6775 · (469) 596-6137
Phone(770) 614-4666
Organization SubpartYes
Authorized OfficialErika Melissa MenjivarSr. Credentialing Specialist · (469) 596-6137
Enumeration DateSeptember 10, 2024
Last NPPES UpdateMarch 17, 20262 updates tracked since enumeration
NPPES CertifiedMarch 17, 2026
✔ NPI 1417783291 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.
1000 PEACHTREE INDUSTRIAL BLVD STE 10, Suwanee, GA 30024
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Other Names 1

Doing Business AsSuwanee Creek 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

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 Ppo's NPI number?

The NPI number for Ga Southern Dental Ppo is 1417783291. It was assigned to this organization in the NPPES registry on September 10, 2024. The provider is doing business as Suwanee Creek Dentistry.

Where is Ga Southern Dental Ppo located?

Ga Southern Dental Ppo is located at 1000 Peachtree Industrial Blvd Ste 10, Suwanee, GA 30024. The listed phone number is (770) 614-4666.

What is Ga Southern Dental Ppo'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 Ppo was last updated on March 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.