Ga Southern Dental LLC
NPI 1053139519ActiveOrganization· Dentist· Macon, GA
Dentist in Macon, Georgia, registered in NPPES in October 2024, part of Ga Southern Dental LLC. The authorized official on file is Erika Melissa Menjivar, Sr. Credentialing Specialist.
Overview
| NPI | 1053139519 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Ga Southern Dental LLC |
| NPI issued | Oct 2, 2024 |
| Last updated in NPPES | Oct 2, 2024 |
| Certified by provider | Oct 2, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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