OrganizationActive
Mark D Thebaut DDS PC
NPI 1447377130 · Pediatric Dentistry · Lilburn, GA
Mark D Thebaut DDS PC is a Pediatric Dentistry organization in Lilburn, GA (NPI 1447377130).
Provider details
- NPI number
- 1447377130
- Entity type
- Organization
- Primary specialty
- Pediatric DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Mark Thebaut, Owner(770) 925-3301
- License
- 9113 (GA)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 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 Nw
Suite a
Lilburn, GA 30047-3401
Phone: (770) 925-3301
Fax: (770) 709-0001
Street-level locationGet directions
Mailing address
609 Beaver Ruin Rd Nw
Lilburn, GA 30047-3401
Other names (DBA / former)
- Doing business as
- Gwinnett Childrens Dentistry
Registry dates
- Enumerated
- 2007-03-26
- Last updated
- 2008-06-18
Frequently asked questions
- What is Mark D Thebaut DDS PC's NPI number?
- Mark D Thebaut DDS PC's National Provider Identifier (NPI) is 1447377130, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Mark D Thebaut DDS PC?
- Mark D Thebaut DDS PC is classified in the NPPES registry as Pediatric Dentistry (Dental Providers).
- Where is Mark D Thebaut DDS PC located?
- Mark D Thebaut DDS PC's practice location on file with NPPES is 609 Beaver Ruin Rd Nw, Lilburn, GA 30047-3401.
- What is Mark D Thebaut DDS PC's phone number?
- The practice phone number listed in the NPPES registry for Mark D Thebaut DDS PC is (770) 925-3301.
- Who is the authorized official for Mark D Thebaut DDS PC?
- The authorized official listed on Mark D Thebaut DDS PC's NPPES record is Mark Thebaut, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Mark D Thebaut DDS PC's NPI active?
- Yes — Mark D Thebaut DDS PC's NPI (1447377130) is active in the NPPES registry as of the last update on 2008-06-18.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.