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Organization
TEBO DENTISTRY FOR KIDS PEACHTREE CORNERS, LLC
Active
Organization
TEBO DENTISTRY FOR KIDS PEACHTREE CORNERS, LLC
Active
Other names
Tebo Dentistry for Kids Peachtree Corners
Organization subpart
No
Provider details
NPI number
Authorized official
MARK THEBAUT (PRESIDENT/OWNER)
(770) 925-3300
Entity
Organization
Contact information
Practice address
6460 SPALDING DRIVE, SUITE C, PEACHTREE CORNERS, GA 30092
(770) 925-3300
Mailing address
PO BOX 1953, LILBURN, GA 30048
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/08/2019
Last updated
06/11/2019
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