| NPI | 1083172035 |
|---|---|
| Doing Business As | TEBO DENTISTRY FOR KIDS PEACHTREE CORNERS |
| Entity Type | Organization |
| Authorized Contact | MARK THEBAUT President/Owner 770-925-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2019-06-11 |