NPI age
16 years
Enumerated 2009-08-17
● Active Type 2 · Organization
Subpart
Platinum Dental Group Lilburn Llc
Platinum Dental Group Lilburn Llc is 1 of 539 dentist organizations in Georgia.
Primary specialty
Dentist
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Thebaut
Owner/dentist
Last NPPES update
2009-08-17
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
0
NPI lifetime · 2009 → 2026
2009-08Enumerated in NPPES
2009
2026
Where they practice
Primary practice location
609 Beaver Ruin Rd., Ste A
Lilburn, GA 30047
Mailing address
Po Box 1953
Lilburn, GA 300481953
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.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 151700972B |
Practice context
Single-site organization. Only one practice location on file.
Subpart of Platinum Dental Group Lilburn Llc.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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