Platinum Dental Group Lilburn, Llc

LBN: Platinum Dental Group Lilburn, Llc
Platinum Dental Group Lilburn, Llc is an health care organization with primary practice located at 609 Beaver Ruin Rd Suite A, Lilburn GA 30047. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / Pediatric Dentistry is the primary health care specialty. Platinum Dental Group Lilburn, Llc can be contacted via phone (770) 709-0000, or through Thebaut, Mark Denny via phone (678) 990-6301.

Contact Information

Primary practice address
609 Beaver Ruin Rd Suite A Lilburn GA 30047
Phone: (770) 709-0000
Fax: (770) 925-3302
Website:
Map and Directions
Authorized official contact:
Name: Thebaut, Mark Denny Doctor of Dental Surgery (DDS)
Phone: (678) 990-6301

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X
Dental Providers / Pediatric Dentistry 1223P0221X

Profile Details

NPI number 1609100015
LBN Legal business name Platinum Dental Group Lilburn, Llc
DBA Doing business as
Authorized official Thebaut, Mark Denny Doctor of Dental Surgery (DDS)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 1st, 2009
Last updated Oct 1st, 2009 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609100015 NPPES
Georgia MEDICAID 000185875J
Georgia MEDICAID 232076497B
Georgia MEDICAID 151700972B
Georgia MEDICAID 591447276C
Georgia MEDICAID 832239687A
Georgia MEDICAID 149199935B

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