Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ga Southern Dental LLC

Organization Dentist · NPI 1053139519

Ga Southern Dental LLC is a Dentist in Macon, Georgia. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

3298 Northside Dr
Macon, GA 31210-2553
Phone: (478) 475-1976
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X

Record details

NPI number1053139519
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationGa Southern Dental LLC
Authorized official Erika Menjivar — Sr. Credentialing Specialist · (469) 596-6137
Other names Northside Dentistry
NPI enumeratedOctober 2, 2024
Last updated in NPPESOctober 2, 2024
Certification dateOctober 2, 2024
Mailing address5830 Granite Pkwy Ste 780, Plano, TX 75024-6775

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