Gwinnett Childrens Dentistry
LBN: Mark D. Thebaut, D.D.S, Pc Dba
Gwinnett Childrens Dentistry is an health care organization with primary practice located at 609 Beaver Ruin Rd Suite A, Lilburn GA 30047. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / Pediatric Dentistry is the primary health care specialty.
Mark D. Thebaut, D.D.S, Pc Dba can be contacted via phone (770) 925-3300, or through Thebaut, Mark Denny via phone (678) 990-6301.
Contact Information
Primary practice address
609 Beaver Ruin Rd Suite A
Lilburn GA 30047
Phone: (770) 925-3300
Fax: (770) 925-3302
Website:
Authorized official contact:
Name: Thebaut, Mark Denny Doctor of Dental Surgery (DDS)
Phone: (678) 990-6301
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | ||
| Dental Providers / Pediatric Dentistry | 1223P0221X |
Profile Details
| NPI number | 1255665667 |
|---|---|
| LBN Legal business name | Mark D. Thebaut, D.D.S, Pc Dba |
| DBA Doing business as | Gwinnett Childrens Dentistry |
| Authorized official | Thebaut, Mark Denny Doctor of Dental Surgery (DDS) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 1st, 2009 |
| Last updated | Oct 1st, 2009 - about 17 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255665667 | NPPES |
| Georgia | MEDICAID | 151700972A | |
| Georgia | MEDICAID | 232076497A | |
| Georgia | MEDICAID | 177273740D | |
| Georgia | MEDICAID | 149199935A | |
| Georgia | MEDICAID | 000185875E | |
| Georgia | MEDICAID | 591447276B |
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