Active NPI
Ga Southern Dental PPO
Doing business as Suwanee Creek Dentistry
- Dentist
- Suwanee, GA
National Provider Identifier
1417783291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Legal business name
- GA SOUTHERN DENTAL PPO
- Doing business as
- Suwanee Creek Dentistry
- Practice address
- 1000 Peachtree Industrial Blvd Ste 10
Suwanee, GA 30024-1977 - Phone
- (770) 614-4666
- NPI assigned
- Sep 10, 2024
- Last updated
- Mar 17, 2026
- Organization subpart
- Yes
- Parent organization
- GA SOUTHERN DENTAL PPO
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Erika Melissa Menjivar
- Title
- Sr. Credentialing Specialist
- Phone
- (469) 596-6137
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | Primary |
Addresses
Primary practice location
1000 Peachtree Industrial Blvd Ste 10
Suwanee, GA 30024-1977
Mailing address
5830 Granite Pkwy Ste 780
Plano, TX 75024-6775
Phone (469) 596-6137
Other names 1
- Suwanee Creek Dentistry
National Provider Directory
National Provider Directory- Tax ID family
- Ga Sothern Dental PPO
- Part of
- Ga Sothern Dental PPO
Other organizations with this tax ID 6
Organizations that report the same tax identification number in the National Provider Directory.
Locations
1000 Peachtree Industrial Blvd
Ste 10
Suwanee, GA 30024
Phone (770) 614-4666
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- General Practice Dentistry
- Suwanee, GA
- NPI 1831315373
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725926400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1773705600000",
"number": "1417783291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5830 GRANITE PKWY STE 780",
"city": "PLANO",
"state": "TX",
"postal_code": "750246775",
"telephone_number": "469-596-6137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 PEACHTREE INDUSTRIAL BLVD STE 10",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300241977",
"telephone_number": "770-614-4666"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GA SOUTHERN DENTAL PPO",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "GA SOUTHERN DENTAL PPO",
"enumeration_date": "2024-09-10",
"last_updated": "2026-03-17",
"certification_date": "2026-03-17",
"status": "A",
"authorized_official_last_name": "MENJIVAR",
"authorized_official_first_name": "ERIKA",
"authorized_official_middle_name": "MELISSA",
"authorized_official_title_or_position": "SR. CREDENTIALING SPECIALIST",
"authorized_official_telephone_number": "469-596-6137"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Suwanee Creek Dentistry",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Suwanee, GA
- Brittany Fuller
- Fusion Sleep Therapy Services
- G. Wells Petras, LLC
- Ga Oms SDS PC
- Ga Oms SDS PC (Signature Dental Implants and Oral Surgery)
- Ga Specialty Dental Services (Paul Korb, DMD Implant Services, Oral & Facial Surgery)
- Ga Specialty Dental Services II, PC (Suwanee Pediatric Dentistry)
- Ga Specialty Dental Services, PC (Signature Dental Implants and Oral Surgery)
- Sailaja K Gadde, M.D.
- Chris Gallagher
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.