MARK D THEBAUT DDS PC (NPI# 1447377130) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447377130 |
| Entity Type | Organization |
| Organization Name | MARK D THEBAUT DDS PC |
| Other Organization Name | GWINNETT CHILDRENS DENTISTRY |
| Practice Address |
609 Beaver Ruin Rd Nw Suite A Lilburn GA 30047-3401 |
| Practice Telephone | 7709253301 |
| Practice Fax Number | 7707090001 |
| Mailing Telephone | 7709253300 |
| Mailing Fax Number | 7709253302 |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2008-06-18 |
| Authorized Official Name | DR. MARK D THEBAUT (OWNER) |
| Authorized Official Telephone | 7709253301 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
9113 | GA | Dental Providers |
| Other Name | Type Code |
|---|---|
| Gwinnett Childrens Dentistry | Doing Business As Name - Organization |
| Street Address |
609 BEAVER RUIN RD NW SUITE A |
| City | LILBURN |
| State | GA |
| Zip Code | 30047-3401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255370565 | Mark Inman Cohen | Dentist | 609 Beaver Ruin Rd Nw, Suite E, Lilburn, GA 30047-3401 | 2006-06-05 |
| 1831291574 | Gregory A Clepper | Dentist | 609 Beaver Ruin Rd Nw, Lilburn, GA 30047-3401 | 2006-09-02 |
| 1245332238 | Mark D Thebaut | Dentist | 609 Beaver Ruin Rd Nw, Lilburn, GA 30047-3401 | 2006-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750861217 | Latrina S Walden | Nurse Practitioner | 887 Ryan Lane, Lilburn, GA 30047 | 2018-08-15 |
| 1811483928 | Olivia Oyegunle | Optometrist | 4153 Lawrenceville Hwy Nw Ste 5, Lilburn, GA 30047 | 2018-07-02 |
| 1932619285 | Mpm Creative, LLC | Speech-Language Pathologist | 1560 Hewatt Rd, Lilburn, GA 30047 | 2017-10-01 |
| 1528515186 | Smith Dental Care of Lilburn, Inc. | Dentist | 3100 Five Forks Trickham Rd Suite 201, Lilburn, GA 30047 | 2016-09-01 |
| 1891143244 | Choices Behavioral Alternatives | Counselor | 4037 Darling Court, Suite B, Lilburn, GA 30047 | 2016-05-26 |
| 1235595687 | Georgia Dental Associates | Clinic/Center | 3100 Five Forks Trickum Road Suite 201, Lilburn, GA 30047 | 2016-01-14 |
| 1912382144 | Sangeetha Asokan | Dentist | 609, Beaver Ruin Road, Tebo Dental for Kids, Lilburn, GA 30047 | 2015-07-29 |
| 1467836403 | Pamela Neal | Registered Nurse | 3315 Landingview Ct, Lilburn, GA 30047 | 2015-07-18 |
| 1699172452 | Josie Kou, Kulah Curran | Registered Nurse | 3708 Tamer Ln, Lilburn, GA 30047 | 2014-11-21 |
| 1184039380 | Cheryl Lee | Chiropractor | 5014 Stone Mountain Hwy, Suite C, Lilburn, GA 30047 | 2014-06-25 |
| Find all providers in zip 30047 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| 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 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962634543 | Platinum Dental Group Lilburn LLC | Dentist | 609 Beaver Ruin Rd., Ste A, Lilburn, GA 30047 | 2009-08-17 |
| 1245332238 | Mark D Thebaut | Dentist | 609 Beaver Ruin Rd Nw, Lilburn, GA 30047-3401 | 2006-09-01 |
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|---|---|---|---|---|
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| 1871145557 | Dogwood Pediatric Dentistry of Statesboro, LLC | Dentist | 123 Hill Pond Ln, Statesboro, GA 30458-0872 | 2019-07-12 |
| 1952969396 | Ns3 Services, LLC | Dentist | 1039 Grant St Se Ste B11, Atlanta, GA 30315-2050 | 2019-05-31 |
| 1871050872 | Warner Robins Pediatric Dentistry LLC | Dentist | 102 S Houston Rd, Warner Robins, GA 31088-3904 | 2019-02-26 |
| 1730646886 | Smiles for Kids Norcross PC | Dentist | 3953 Holcomb Bridge Rd Ste 100, Peachtree Corners, GA 30092-5201 | 2019-02-25 |
| 1073083127 | Pediatric Dentistry of Central Georgia - Macon LLC | Dentist | 5437 Bowman Rd Ste 300, Macon, GA 31210-6575 | 2018-12-03 |
| Find all providers with the same taxonomy | ||||
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| 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.