Ga Southern Dental PPO
NPI 1902695521ActiveOrganization· Dentist· Marietta, GA
Dentist in Marietta, Georgia, registered in NPPES in May 2025, part of Ga Southern Dental PPO. The authorized official on file is Erika Melissa Menjivar, Sr. Credentialing Specialist.
Overview
| NPI | 1902695521 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Ga Southern Dental PPO |
| NPI issued | May 1, 2025 |
| Last updated in NPPES | May 1, 2025 |
| Certified by provider | May 1, 2025 |
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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