NPI age
— years
Enumerated 2026-02-23
● Active Type 2 · Organization
Subpart
Ga Southern Dental Llc
Ga Southern Dental Llc is 1 of 2660 dentist organizations in Georgia.
Primary specialty
Dentist
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Menjivar
SR. Credentialing Specialist
Last NPPES update
2026-02-23
Source: monthly bulk 2026-05
How this organization compares
Across 2660 active dentist providers in Georgia.
NPI age
0 years
↓ 14 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2026 → 2026
2026-02Enumerated in NPPES
2026
2026
Where they practice
Primary practice location
1225 Johnson Ferry Rd Ste 660
Marietta, GA 300682772
Mailing address
5830 Granite Pkwy Ste 780
Plano, TX 750246775
Authorized official
Erika Melissa Menjivar
SR. Credentialing Specialist
📞 4695966137
Individual providers at this organization
1 individual provider on file at this primary practice address.
- Ivan Warner Dentist NPI 1619655230
Specialties
-
Dentist PrimaryA 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...
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Georgia Dental Medicine
Practice context
Multi-provider organization. 1 individual provider on file at this primary address.
Subpart of Ga Southern Dental Llc.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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