| NPI | 1609100015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DENNY THEBAUT Owner/Dentist 678-990-6301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2009-10-01 |