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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