Organization
MARK D. THEBAUT, D.D.S, PC DBA
Active
Other names
Gwinnett Childrens Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK DENNY THEBAUT DDS (OWNER/DENTIST)
(678) 990-6301
Entity
Organization
Contact information
Practice address
609 BEAVER RUIN RD, SUITE A, LILBURN, GA 30047
(770) 925-3300
(770) 925-3302
Mailing address
609 BEAVER RUIN RD, SUITE A, LILBURN, GA 30047
(770) 925-3300
(770) 925-3302
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000185875E
—
GA
05
—
149199935A
—
GA
05
—
151700972A
—
GA
05
—
177273740D
—
GA
05
—
232076497A
—
GA
05
—
591447276B
—
GA
Enumeration date
10/01/2009
Last updated
10/01/2009
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us