| Platinum Dental Group Lilburn Llc | |
|
609 Beaver Ruin Rd. Ste A Lilburn GA 30047 | |
| (770) 709-0000 | |
| (770) 925-3302 |
| Full Name | Platinum Dental Group Lilburn Llc |
|---|---|
| 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 |
|---|---|
| Platinum Dental Group Lilburn Llc Po Box 1953 Lilburn GA 30048-1953 Ph: (770) 709-0000 | Platinum Dental Group Lilburn Llc 609 Beaver Ruin Rd. Ste A Lilburn GA 30047 Ph: (770) 709-0000 |
| NPI Number | 1962634543 |
|---|---|
| Provider Enumeration Date | 08/17/2009 |
| Last Update Date | 08/17/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962634543 | NPI | - | NPPES |
| 151700972B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN009113 (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 | |
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 | |
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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 | |
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