| Gwinnett Childrens Dentistry | |
|
609 Beaver Ruin Rd Suite A Lilburn GA 30047 | |
| (770) 925-3300 | |
| (770) 925-3302 |
| Full Name | Gwinnett Childrens Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 609 Beaver Ruin Rd, Lilburn, Georgia |
| Authorized Official Name and Position | Mark Denny Thebaut (OWNER/DENTIST) |
| Authorized Official Contact | 6789906301 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gwinnett Childrens Dentistry 609 Beaver Ruin Rd Suite A Lilburn GA 30047 Ph: (770) 925-3300 | Gwinnett Childrens Dentistry 609 Beaver Ruin Rd Suite A Lilburn GA 30047 Ph: (770) 925-3300 |
| NPI Number | 1255665667 |
|---|---|
| Provider Enumeration Date | 10/01/2009 |
| Last Update Date | 10/01/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255665667 | NPI | - | NPPES |
| 151700972A | Medicaid | GA | |
| 232076497A | Medicaid | GA | |
| 177273740D | Medicaid | GA | |
| 149199935A | Medicaid | GA | |
| 000185875E | Medicaid | GA | |
| 591447276B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
Kool Smiles Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4030 Lawrenceville Highway #13, Lilburn, GA 30047 Phone: 678-252-5665 Fax: 678-252-5666 | |
Dentistry N Orthodontics Kennesaw Point At Lilburn Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 733 Pleasant Hill Rd Nw Ste 1202, Lilburn, GA 30047 Phone: 678-580-3060 Fax: 770-557-1126 | |
Zoom Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4574 Lawrenceville Hwy Nw, 120, Lilburn, GA 30047 Phone: 770-921-9000 Fax: 770-931-7704 | |
Elrod And Price, P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3997 Lawrenceville Hwy Nw, Suite 210, Lilburn, GA 30047 Phone: 770-921-6001 Fax: 770-921-6003 | |
Gwinnett Family Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 504 Indian Trail Lilburn Rd Nw, Suite 100, Lilburn, GA 30047 Phone: 770-921-5100 | |
Alan C. Tucker, D.d.s., P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 639a Beaver Ruin Rd Nw, Lilburn, GA 30047 Phone: 770-923-5200 Fax: 770-564-0613 | |
James R Williamson Dmd Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 504 Indian Trail Road, Suite 100, Lilburn, GA 30047 Phone: 770-921-5100 Fax: 770-381-9038 |