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Dr. Mark D Thebaut, DDS
Pediatric Dentist in Lilburn, Georgia
NPI 1245332238

Mark D Thebaut is a Pediatric Dentist based in Lilburn, GA and is specialized in Pediatric Dentistry. Mark D Thebaut practices in Lilburn, GA and has the professional credentials of DDS. The NPI Number for Mark D Thebaut is 1245332238 and holds a License No. 9113 (Georgia).

The current practice location address for Mark D Thebaut is 609 Beaver Ruin Rd Nw, Lilburn, GA and can be reached out via phone at 770-925-3300 and via fax at 770-925-3302.

Location: 609 Beaver Ruin Rd Nw, Lilburn, GA, 30047-3401
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1245332238
Provider Name
Mark D Thebaut
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
609 Beaver Ruin Rd Nw, Lilburn, GA, 30047-3401
Phone Number
770-925-3300
Fax Number
770-925-3302
Provider Enumeration Date
09/01/2006
Last Update Date
03/08/2024
institution
Provider Business Practice Location Address Details
Address
609 Beaver Ruin Rd Nw
City
Lilburn
State
Georgia
Zip
30047-3401
Phone Number
770-925-3300
Fax Number
770-925-3302
person
Provider Business Mailing Address Details
Address
609 Beaver Ruin Rd Nw
City
Lilburn
State
Georgia
Zip
30047-3401
Phone Number
770-925-3300
Fax Number
770-925-3302
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
9113 (Georgia)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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