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Mark D Thebaut Dds Pc
Pediatric Dentist in Lilburn, Georgia
NPI 1447377130

Mark D Thebaut Dds Pc is a Pediatric Dentist based in Lilburn, GA and is specialized in Pediatric Dentistry. Mark D Thebaut Dds Pc practices in Lilburn, GA. The NPI Number for Mark D Thebaut Dds Pc is 1447377130 and holds a License No. 9113 (Georgia).

The current practice location address for Mark D Thebaut Dds Pc is 609 Beaver Ruin Rd Nw, Lilburn, GA and can be reached out via phone at 770-925-3301 and via fax at 770-709-0001.

Location: 609 Beaver Ruin Rd Nw, Lilburn, GA, 30047-3401
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1447377130
Provider Name
Mark D Thebaut Dds Pc
Credential
Provider Entity Type
Organization
Address
609 Beaver Ruin Rd Nw, Lilburn, GA, 30047-3401
Phone Number
770-925-3301
Fax Number
770-709-0001
Provider Enumeration Date
03/26/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
609 Beaver Ruin Rd Nw
City
Lilburn
State
Georgia
Zip
30047-3401
Phone Number
770-925-3301
Fax Number
770-709-0001
person
Provider Business Mailing Address Details
Address
609 Beaver Ruin Rd Nw
City
Lilburn
State
Georgia
Zip
30047-3401
Phone Number
770-925-3301
Fax Number
770-709-0001
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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