| NPI | 1962634543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DENNY THEBAUT Owner/Dentist 678-990-6301 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN009113) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2009-08-17 |