| NPI | 1154448850 |
|---|---|
| Former Legal Business Name | PLATINUM DENTAL LILBURN, LLC |
| Entity Type | Organization |
| Authorized Contact | MARK D THEBAUT Owner 770-709-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 9113) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2009-03-25 |