Active NPI
Ga Southern Dental PPO
Doing business as Mallard Cove Dental
- Dentist
- Atlanta, GA
National Provider Identifier
1619898509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Legal business name
- GA SOUTHERN DENTAL PPO
- Doing business as
- Mallard Cove Dental
- Practice address
- 1820 The Exchange SE Ste 700
Atlanta, GA 30339-2083 - Phone
- (770) 980-0232
- NPI assigned
- Jul 24, 2026
- Last updated
- Jul 24, 2026
- Organization subpart
- Yes
- Parent organization
- GA SOTHERN 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
1820 The Exchange SE Ste 700
Atlanta, GA 30339-2083
Mailing address
5830 Granite Pkwy Ste 780
Plano, TX 75024-6775
Other names 1
- Mallard Cove Dental
National Provider Directory
National Provider Directory- Tax ID family
- Ga Southern Dental PPO
Other organizations with this tax ID 6
Organizations that report the same tax identification number in the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1784851200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1784851200000",
"number": "1619898509",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1820 THE EXCHANGE SE STE 700",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303392083",
"telephone_number": "770-980-0232"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GA SOUTHERN DENTAL PPO",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "GA SOTHERN DENTAL PPO",
"enumeration_date": "2026-07-24",
"last_updated": "2026-07-24",
"certification_date": "2026-07-24",
"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": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Mallard Cove Dental",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Atlanta, GA
- Ga SDS III PC (Elite Smiles Orthodontics)
- Ga Smile Center
- Ga Southern Dental LLC (MidCIty Dentistry)
- Ga Southern Dental LLC (Mallard Cove Dental)
- Ga Southern Dental LLC (Intown Smile Studio)
- Ga Southern Dental PPO (Collier Hills Dentistry)
- Ga Sprout MC 1 LLC (Elemy)
- Ga Wound Care Medical Group
- Trenton Gaasch, O.D.
- Benjamin Thomas Gabanic
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.