TEBO DENTISTRY FOR KIDS MARIETTA LLC


Address: 2155 Post Oak Tritt Rd, Suite 450, Marietta, GA 30062-8620
Phone: 7709253300

TEBO DENTISTRY FOR KIDS MARIETTA LLC (NPI# 1396106142) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1396106142
Entity Type Organization
Organization Name TEBO DENTISTRY FOR KIDS MARIETTA LLC
Practice Address 2155 Post Oak Tritt Rd
Suite 450
Marietta
GA 30062-8620
Mailing Address Po Box 1953
Lilburn
GA 30048-1953
Practice Telephone 7709253300
Enumeration Date 2016-03-08
Last Update Date 2016-03-08
Authorized Official Name DR. MARK DENNY THEBAUT (PRESIDENT/OWNER)
Authorized Official Telephone 7709253300
Authorized Official Credential D.D.S.
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1223P0221X Dentist
Specialization: Pediatric Dentistry
Dental Providers

Office Location

Street Address 2155 POST OAK TRITT RD
SUITE 450
City MARIETTA
State GA
Zip Code 30062-8620

Providers in the same location

NPI Name Taxonomy Address Enumeration
1003804774 Nicole A Smail Pediatrics 2155 Post Oak Tritt Rd, Suite 100, Marietta, GA 30062 2005-10-07
1891295762 Stephanie Marie Leslie Physical Therapist 2155 Post Oak Tritt Rd, Marietta, GA 30062-8620 2018-02-17
1245607530 Jayveliyathmdinc Clinic/Center 2155 Post Oak Tritt Rd, Ste580, Marietta, GA 30062-8620 2015-08-21
1578904033 Christine A Chernik Nurse Practitioner 2155 Post Oak Tritt Rd, Suite 100, Marietta, GA 30062-8620 2013-07-12
1982979753 Richard Walls, Dmd,pc Dentist 2155 Post Oak Tritt Rd, Suite 500, Marietta, GA 30062-8620 2012-03-13
1265759229 Anna Chandler Schulenborg Pediatrics 2155 Post Oak Tritt Rd, Suite 100, Marietta, GA 30062-8620 2010-04-29
1831359389 Richard Craig Bien Pediatrics 2155 Post Oak Tritt Rd, Suite 100, Marietta, GA 30062-8620 2008-06-09
1154590982 Primary Health Care P. C. Internal Medicine 2155 Post Oak Tritt Rd, Suite 580, Marietta, GA 30062-8620 2008-02-26
1770752990 Harold Owen Enoch Dentist 2155 Post Oak Tritt Rd, Suite 180, Marietta, GA 30062-8620 2008-02-21
1114138567 Karin Kay Hetherington Physical Therapist 2155 Post Oak Tritt Rd, Suite 400, Marietta, GA 30062-8620 2007-05-25
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1619578051 Pamela D Kretzmer Social Worker 3855 Shallowford Road, Suite 420, Marietta, GA 30062 2020-11-03
1932714680 Michelle Chambless Physical Therapist Team Rehabilitation Ga01, LLC, 1401 Johnson Ferry Road, Suite 340, Marietta, GA 30062 2020-09-10
1700408887 Life University Chiropractor 1323 Roswell Road, Marietta, GA 30062 2020-05-12
1104451160 Sno Healthcare Group Clinic/Center 2424 Roswell Rd Ste 120, Marietta, GA 30062 2020-03-10
1811536212 Sandy Plains Dental Group, PC Dentist 3460 Sandy Plains Rd, Suite 240, Marietta, GA 30062 2020-01-02
1073159034 Magdala Tulcie Jodesty-jackson Social Worker 4343 Shalloword Road, Building H, Suite 4 Lower Level, Marietta, GA 30062 2019-11-25
1598235178 Matthew Driggers Counselor 4343 Shallowford Rd C2, Marietta, GA 30062 2018-11-27
1750895785 Emily Grace Minday Counselor 4343 Shallowford Road Building C, Suite 1 Lower Level, Marietta, GA 30062 2017-11-29
1477072122 Jason Lee Amos Speech-Language Pathologist 3660 Chestnut Ridge Court, Marietta, GA 30062 2017-09-13
1346761376 Marian Pomaah Opoku-agyeman Nurse Practitioner 4661 Andrea Pointe, Marietta, GA 30062 2017-06-29
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Taxonomy Information

Taxonomy Code 1223P0221X
Grouping Dental Providers
Classification Dentist
Specialization Pediatric Dentistry

Taxonomy Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Notes: Source: Council on Dental Education and Licensure, American Dental Association

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1003352857 Kimchang & Company, LLC Dentist 2155 Post Oak Tritt Rd Ste 450, Marietta, GA 30062-8608 2017-01-17
1003366147 East Cobb Nia LLC Dentist 1111 Johnson Ferry Rd, Marietta, GA 30068-2181 2016-10-13
1407993827 Priya N Dixit Dentist 2880 Johnson Ferry Rd Ste 100, Marietta, GA 30062-8368 2007-02-01
1821152364 Michael Rossitch Dentist 3698 Largent Way Nw, Suite 201, Marietta, GA 30064-5923 2006-12-20
1053413906 Nelson K Allen Dentist 2880 Johnson Ferry Rd, Suite 100, Marietta, GA 30062-8368 2006-09-02
1154365161 Marc Andrew Auerbach Dentist 1090 Northchase Pkwy Se, Suite 290, Marietta, GA 30067-6405 2006-06-16
1659313856 Terry W. Holder Dentist 5107 Township Ridge Trce, Marietta, GA 30066-1733 2006-06-12
1679922470 South Indy Dental, P.C. Dentist 1090 Northchase Pkwy Se, Ste. 150, Marietta, GA 30067-6405 2016-06-13
1982073441 John Hampton Taylor Dentist 1230 Johnson Ferry Rd, Suite I-10, Marietta, GA 30068-2048 2015-09-15
1124404520 Jorge Del Cuadro Dentist 1090 Northchase Pkwy Se Ste 290, Marietta, GA 30067-6402 2015-08-07
Find all providers in MARIETTA

Competitor

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City MARIETTA
Zip Code 30062

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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