Organization · Type 2 NPI
Mark D. Thebaut, D.d.s, PC dba
Pediatric Dentistry · Lilburn, GA
NPI number
1255665667
Active
Practice location
609 Beaver Ruin Rd, Suite A
Lilburn, GA 30047
Fax (770) 925-3302
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| General Practice Dentistry | 1223G0001X | None listed |
| Pediatric Dentistry Primary | 1223P0221X | None listed |
Pediatric Dentistry: 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.
Another provider at this address
Other pediatric dentistry providers in Lilburn
About NPI 1255665667
Mark D. Thebaut, D.d.s, PC dba's National Provider Identifier is 1255665667, issued on Oct 1, 2009. The primary taxonomy on file is Pediatric Dentistry (1223P0221X), and the practice location is in Lilburn, GA. The record was last updated on Oct 1, 2009.