Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mark D. Thebaut, D D S, PC Dba

Organization General Practice Dentistry · NPI 1255665667

Mark D. Thebaut, D D S, PC Dba is a General Practice Dentistry in Lilburn, Georgia. Registered with an NPI since 2009.

In the registry since
2009
Specialties on file
2
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

609 Beaver Ruin Rd Ste A
Lilburn, GA 30047
Phone: (770) 925-3300
Fax: (770) 925-3302
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Dentistry (primary) Taxonomy 1223P0221X
General Practice Dentistry Taxonomy 1223G0001X

Record details

NPI number1255665667
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mark Thebaut — Owner/Dentist · (678) 990-6301
Other names Gwinnett Childrens Dentistry
NPI enumeratedOctober 1, 2009
Last updated in NPPESOctober 1, 2009
Mailing address609 Beaver Ruin Rd, Suite A, Lilburn, GA 30047

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