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

Mark D Thebaut DDS PC

Organization Pediatric Dentistry · NPI 1447377130

Mark D Thebaut DDS PC is a Pediatric Dentistry in Lilburn, Georgia. Licensed in Georgia. Registered with an NPI since 2007.

Licensed in
GA
In the registry since
2007
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 NW Ste A
Lilburn, GA 30047-3401
Phone: (770) 925-3301
Fax: (770) 709-0001
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Dentistry (primary) Taxonomy 1223P0221X · Licence 9113 (GA)

Record details

NPI number1447377130
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mark Thebaut — Owner · (770) 925-3301
Other names Gwinnett Childrens Dentistry
NPI enumeratedMarch 26, 2007
Last updated in NPPESJune 18, 2008
Mailing address609 Beaver Ruin Rd Nw, Suite A, Lilburn, GA 30047-3401

Other providers in Lilburn