PLATINUM DENTAL GROUP LILBURN, LLC
NPI 1609100015
Dentist - Pediatric Dentistry in Lilburn, GA

Q: What is Platinum Dental Group Lilburn, LLC's NPI number?

The NPI number for Platinum Dental Group Lilburn, LLC is 1609100015. It was assigned to this organization in the NPPES registry on October 1, 2009.

Q: What is Platinum Dental Group Lilburn, LLC's specialty?

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

Active since October 01, 2009

609 BEAVER RUIN RD, SUITE A, LILBURN, GA 30047(770) 709-0000(770) 925-3302 Get Directions Write a Review

NPPES record last updated: October 1, 2009. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Platinum Dental Group Lilburn, Llc NPPES

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

PLATINUM DENTAL GROUP LILBURN, LLC (NPI 1609100015) 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

NPI1609100015

Entity TypeOrganization

Primary Taxonomy1223P0221X

Legal Business NamePLATINUM DENTAL GROUP LILBURN, LLC

Location Address609 BEAVER RUIN RD, SUITE ALilburn, GA 30047

Mailing Address609 Beaver Ruin Rd, Suite ALilburn, GA 30047 · (770) 709-0000 · Fax (770) 925-3302

Phone(770) 709-0000

Fax(770) 925-3302

Organization SubpartNo

Authorized OfficialMark Denny ThebautOwner/dentist · (678) 990-6301

Enumeration DateOctober 1, 2009

✔ NPI 1609100015 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 Identifiers 6

Medicaid832239687AGA

Medicaid151700972BGA

Medicaid149199935BGA

Medicaid232076497BGA

Medicaid000185875JGA

Medicaid591447276CGA

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.

MARK D. THEBAUT, D.D.S, PC DBA

Dentist (Pediatric Dentistry)

609 BEAVER RUIN RD, SUITE A
LILBURN, GA 30047

Gwinnett County (770) 925-3300

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 Platinum Dental Group Lilburn, LLC's NPI number?

The NPI number for Platinum Dental Group Lilburn, LLC is 1609100015. It was assigned to this organization in the NPPES registry on October 1, 2009.

Where is Platinum Dental Group Lilburn, LLC located?

Platinum Dental Group Lilburn, LLC is located at 609 Beaver Ruin Rd Suite A, Lilburn, GA 30047. The listed phone number is (770) 709-0000.

What is Platinum Dental Group Lilburn, LLC'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 Platinum Dental Group Lilburn, LLC 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.