NPI age
16 years
Enumerated 2009-10-01
● Active Type 2 · Organization
Mark D. Thebaut, D.d.s, Pc Dba
Mark D. Thebaut, D.d.s, Pc Dba is 1 of 539 dentist organizations in Georgia.
Primary specialty
Dentist
Plus 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Thebaut
Owner/dentist
Last NPPES update
2009-10-01
Source: monthly bulk 2026-05
How this organization compares
Across 539 active dentist providers in Georgia.
NPI age
16 years
≈ at median (16 yr)
Practice locations
1
0 secondary on file
Subspecialties
1
In the 26% of peers with subspecialties
NPI lifetime · 2009 → 2026
2009-10Enumerated in NPPES
2009
2026
Where they practice
Primary practice location
609 Beaver Ruin Rd, Suite A
Lilburn, GA 30047
Mailing address
609 Beaver Ruin Rd, Suite A
Lilburn, GA 30047
Authorized official
Mark Denny Thebaut, DDS
Owner/dentist
📞 6789906301
Specialties
-
Dentist PrimaryAn age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
-
DentistA general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 151700972A | |
| 05 (GA) | 232076497A | |
| 05 (GA) | 177273740D | |
| 05 (GA) | 149199935A | |
| 05 (GA) | 000185875E | |
| 05 (GA) | 591447276B |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Gwinnett Childrens Dentistry
Practice context
Single-site organization. Only one practice location on file.
Provyx · Custom healthcare lists
Need all 539 Dentist providers in Georgia?
Get the full list as a CSV with verified work emails, direct phones, and LinkedIn URLs.
Request a quote →How to verify this organization
- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.