| NPI | 1447377130 |
|---|---|
| Doing Business As | GWINNETT CHILDRENS DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | MARK D THEBAUT Owner 770-925-3301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 9113) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2008-06-18 |