Platinum Dental of Lilburn

NPI #1154448850 in Lilburn, Georgia

Provider Information

NPI Number: 1154448850
Entity Type: Organization
Organization Name: Platinum Dental of Lilburn
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 26, 2007
Last Updated: Mar 25, 2009

Practice Location

Address: 609 BEAVER RUIN RD NW STE A
City: Lilburn
State: Georgia
ZIP Code: 30047-3401
Phone: (770) 709-0000

Authorized Official

Name: DR. MARK D THEBAUT, DDS
Title: OWNER
Phone: (770) 709-0000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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