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

Ga Southern Dental PPO

Organization Dentist · NPI 1417783291

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

In the registry since
2024

Practice location Address checks out

1000 Peachtree Industrial Blvd Ste 10
Suwanee, GA 30024-1977
Phone: (770) 614-4666
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 number1417783291
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationGa Southern Dental PPO
Authorized official Erika Menjivar — Sr. Credentialing Specialist · (469) 596-6137
Other names Suwanee Creek Dentistry
NPI enumeratedSeptember 10, 2024
Last updated in NPPESMarch 17, 2026
Certification dateMarch 17, 2026
Mailing address5830 Granite Pkwy Ste 780, Plano, TX 75024-6775

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