Organization
PLATINUM DENTAL OF LILBURN
Active
Other names
Platinum Dental Lilburn, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK D THEBAUT DDS (OWNER)
(770) 709-0000
Entity
Organization
Contact information
Practice address
609 BEAVER RUIN RD NW STE A, LILBURN, GA 30047-3401
(770) 709-0000
(770) 925-3302
Mailing address
609 BEAVER RUIN RD NW STE A, LILBURN, GA 30047-3401
(770) 709-0000
(770) 925-3302
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9113
GA
Other
Enumeration date
03/26/2007
Last updated
03/25/2009
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