| Ga Southern Dental Ppo | |
|
7407 N Lake Loop Columbus GA 31909-2577 | |
| (706) 323-8811 | |
| Not Available |
| Full Name | Ga Southern Dental Ppo |
|---|---|
| Speciality | Dentist |
| Location | 7407 N Lake Loop, Columbus, Georgia |
| Authorized Official Name and Position | Erika Menjivar (CREDENTIALING MANAGER) |
| Authorized Official Contact | 4695966137 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ga Southern Dental Ppo 5830 Granite Pkwy Ste 780 Plano TX 75024-6775 Ph: () - | Ga Southern Dental Ppo 7407 N Lake Loop Columbus GA 31909-2577 Ph: (706) 323-8811 |
| NPI Number | 1215891049 |
|---|---|
| Provider Enumeration Date | 12/15/2025 |
| Last Update Date | 12/16/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215891049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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