Organization
TEBO DENTISTRY FOR KIDS MARIETTA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK DENNY THEBAUT D.D.S. (PRESIDENT/OWNER)
(770) 925-3300
Entity
Organization
Contact information
Practice address
2155 POST OAK TRITT RD, SUITE 450, MARIETTA, GA 30062-8620
(770) 925-3300
Mailing address
PO BOX 1953, LILBURN, GA 30048-1953
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
03/08/2016
Last updated
03/08/2016
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