OrganizationActive
Mark D. Thebaut, D.D.S, PC Dba
NPI 1255665667 · Pediatric Dentistry · Lilburn, GA
Mark D. Thebaut, D.D.S, PC Dba is a Pediatric Dentistry organization in Lilburn, GA (NPI 1255665667).
Provider details
- NPI number
- 1255665667
- Entity type
- Organization
- Primary specialty
- Pediatric DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Mark Thebaut, Owner/Dentist(678) 990-6301
Specialties & taxonomies
Dental Providers
- General Practice Dentistry1223G0001X
Dental Providers
Profile Score
Detailed profile(84/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
609 Beaver Ruin Rd
Suite a
Lilburn, GA 30047
Phone: (770) 925-3300
Fax: (770) 925-3302
Street-level locationGet directions
Mailing address
609 Beaver Ruin Rd
Lilburn, GA 30047
Other names (DBA / former)
- Doing business as
- Gwinnett Childrens Dentistry
Registry dates
- Enumerated
- 2009-10-01
- Last updated
- 2009-10-01
Frequently asked questions
- What is Mark D. Thebaut, D.D.S, PC Dba's NPI number?
- Mark D. Thebaut, D.D.S, PC Dba's National Provider Identifier (NPI) is 1255665667, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Mark D. Thebaut, D.D.S, PC Dba?
- Mark D. Thebaut, D.D.S, PC Dba is classified in the NPPES registry as Pediatric Dentistry (Dental Providers).
- Where is Mark D. Thebaut, D.D.S, PC Dba located?
- Mark D. Thebaut, D.D.S, PC Dba's practice location on file with NPPES is 609 Beaver Ruin Rd, Lilburn, GA 30047.
- What is Mark D. Thebaut, D.D.S, PC Dba's phone number?
- The practice phone number listed in the NPPES registry for Mark D. Thebaut, D.D.S, PC Dba is (770) 925-3300.
- Who is the authorized official for Mark D. Thebaut, D.D.S, PC Dba?
- The authorized official listed on Mark D. Thebaut, D.D.S, PC Dba's NPPES record is Mark Thebaut, Owner/Dentist. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Mark D. Thebaut, D.D.S, PC Dba's NPI active?
- Yes — Mark D. Thebaut, D.D.S, PC Dba's NPI (1255665667) is active in the NPPES registry as of the last update on 2009-10-01.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.