Organization
PLATINUM DENTAL OF GAINESVILLE
Active
Other names
Platinum Dental Gainesville, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK D THEBAUT DDS (OWNER)
(770) 534-5374
Entity
Organization
Contact information
Practice address
3535 THOMPSON BRIDGE RD, GAINESVILLE, GA 30506-1551
(770) 534-5374
(770) 534-5591
Mailing address
3535 THOMPSON BRIDGE RD, GAINESVILLE, GA 30506-1551
(770) 534-5374
(770) 534-5591
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
9113
GA
1223P0221X
Pediatric Dentistry
Primary
9113
GA
Other
Enumeration date
03/29/2007
Last updated
09/11/2025
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