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GWINNETT CHILDRENS DENTISTRY
NPI 1255665667
Dentist - Pediatric Dentistry in Lilburn, GA

Active since October 01, 2009
609 BEAVER RUIN RD, SUITE A, LILBURN, GA 30047(770) 925-3300(770) 925-3302 Get Directions Write a Review

NPPES record last updated: October 1, 2009. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Gwinnett Childrens Dentistry NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GWINNETT CHILDRENS DENTISTRY (NPI 1255665667) is a healthcare organization registered as a pediatric dentistry in Lilburn, Georgia and active in the NPI registry since October 2009. The organization lists Mark Denny Thebaut, Owner/dentist, as its authorized official.

NPPES Registry Identity

NPI1255665667
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NameMARK D. THEBAUT, D.D.S, PC DBA
Location Address609 BEAVER RUIN RD, SUITE ALilburn, GA 30047
Mailing Address609 Beaver Ruin Rd, Suite ALilburn, GA 30047 · (770) 925-3300 · Fax (770) 925-3302
Phone(770) 925-3300
Fax(770) 925-3302
Organization SubpartNo
Authorized OfficialMark Denny ThebautOwner/dentist · (678) 990-6301
Enumeration DateOctober 1, 2009
✔ NPI 1255665667 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
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.
Also ListedDentist · General PracticeTaxonomy 1223G0001X
609 BEAVER RUIN RD, Lilburn, GA 30047
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Other Names 1

Doing Business AsGwinnett Childrens Dentistry

Other Identifiers 6

Medicaid232076497AGA
Medicaid151700972AGA
Medicaid000185875EGA
Medicaid591447276BGA
Medicaid149199935AGA
Medicaid177273740DGA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PLATINUM DENTAL GROUP LILBURN, LLC
Dentist (Pediatric Dentistry)
609 BEAVER RUIN RD, SUITE A
LILBURN, GA 30047
Gwinnett County (770) 709-0000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark D. Thebaut, D.D.S, PC Dba's NPI number?

The NPI number for Mark D. Thebaut, D.D.S, PC Dba is 1255665667. It was assigned to this organization in the NPPES registry on October 1, 2009. The provider is doing business as Gwinnett Childrens Dentistry.

Where is Mark D. Thebaut, D.D.S, PC Dba located?

Mark D. Thebaut, D.D.S, PC Dba is located at 609 Beaver Ruin Rd Suite A, Lilburn, GA 30047. The listed phone number is (770) 925-3300.

What is Mark D. Thebaut, D.D.S, PC Dba's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Mark D. Thebaut, D.D.S, PC Dba was last updated on October 1, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.