Organization
TEBO DENTISTRY FOR KIDS CUMMING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK THEBAUT (DDS)
(770) 925-3300
Entity
Organization
Contact information
Practice address
1725 BUFORD HWY, CUMMING, GA 30041-8201
(770) 925-3300
(770) 925-3301
Mailing address
PO BOX 1953, LILBURN, GA 30048-1953
(770) 925-3300
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/13/2023
Last updated
01/13/2023
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