Organization
PLATINUM DENTAL GROUP SURGICAL CENTER
Active
Other names
Platinum Dental Group Surgical Center, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK D THEBAUT DDS (OWNER)
(770) 751-3115
Entity
Organization
Contact information
Practice address
1345 HEMBREE RD, ROSWELL, GA 30076-3816
(770) 751-3115
(678) 990-1065
Mailing address
1345 HEMBREE RD, ROSWELL, GA 30076-3816
(770) 751-3115
(678) 990-1065
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
9113
GA
1223P0221X
Pediatric Dentistry
Primary
9113
GA
Other
Enumeration date
03/26/2007
Last updated
09/11/2025
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