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 provides Dentist services 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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