PLATINUM DENTAL GROUP LILBURN LLC
NPI 1962634543
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 1962634543. It was assigned to this organization in the NPPES registry on August 17, 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 August 17, 2009

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

NPPES record last updated: August 17, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

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 1962634543) is a healthcare organization registered as a pediatric dentistry in Lilburn, Georgia and active in the NPI registry since August 2009. The organization lists Mark Denny Thebaut, Owner/dentist, as its authorized official.

NPPES Registry Identity

NPI1962634543

Entity TypeOrganization

Primary Taxonomy1223P0221X

Legal Business NamePLATINUM DENTAL GROUP LILBURN LLC

Location Address609 BEAVER RUIN RD., STE ALilburn, GA 30047

Mailing AddressPo Box 1953Lilburn, GA 30048-1953 · (770) 709-0000 · Fax (770) 925-3302

Phone(770) 709-0000

Fax(770) 925-3302

Organization SubpartYes

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

Enumeration DateAugust 17, 2009

✔ NPI 1962634543 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

License✔ Licensed in GA · DN009113

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.

609 BEAVER RUIN RD., Lilburn, GA 30047

Open in Google Maps ↗

Other Identifiers 1

Medicaid151700972BGA

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

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 1962634543. It was assigned to this organization in the NPPES registry on August 17, 2009.

Where is Platinum Dental Group Lilburn LLC located?

Platinum Dental Group Lilburn LLC is located at 609 Beaver Ruin Rd. Ste 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 August 17, 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.