| Gwinnett Childrens Dentistry | |
|
609 Beaver Ruin Rd Nw Suite A Lilburn GA 30047-3401 | |
| (770) 925-3301 | |
| (770) 709-0001 |
| Full Name | Gwinnett Childrens Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 609 Beaver Ruin Rd Nw, Lilburn, Georgia |
| Authorized Official Name and Position | Mark D Thebaut (OWNER) |
| Authorized Official Contact | 7709253301 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gwinnett Childrens Dentistry 609 Beaver Ruin Rd Nw Suite A Lilburn GA 30047-3401 Ph: (770) 925-3300 | Gwinnett Childrens Dentistry 609 Beaver Ruin Rd Nw Suite A Lilburn GA 30047-3401 Ph: (770) 925-3301 |
| NPI Number | 1447377130 |
|---|---|
| Provider Enumeration Date | 03/26/2007 |
| Last Update Date | 06/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447377130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 9113 (Georgia) | 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 | |
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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 | |
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