| NPI | 1427178201 |
|---|---|
| Doing Business As | PLATINUM DENTAL GAINESVILLE, LLC |
| Entity Type | Organization |
| Authorized Contact | MARK D THEBAUT Owner 770-534-5374 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 9113) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 9113) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2020-08-22 |