Tebo Dentistry for Kids Peachtree Corners, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

TEBO DENTISTRY FOR KIDS PEACHTREE CORNERS, LLC

Practice address

6460 Spalding Drive
Suite C
Peachtree Corners, GA 30092

Phone

(770) 925-3300

NPI assigned

Mar 8, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark ThebautNPI 1245332238

Title

President/Owner

Phone

(770) 925-3300

Specialties & licenses 1

Addresses

Other names 1

• Tebo Dentistry for Kids Peachtree Corners Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark D Thebaut, DDS

  • Pediatric Dentistry
  • Lilburn, GA
  • NPI 1245332238
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1083172035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1953",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "30048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6460 SPALDING DRIVE",
            "address_2": "SUITE C",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "30092",
            "telephone_number": "770-925-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEBO DENTISTRY FOR KIDS PEACHTREE CORNERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-08",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "THEBAUT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "770-925-3300"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tebo Dentistry for Kids Peachtree Corners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Suburban Medical Center
• Suburban Retina Associates LLC
• Suburban Retina Surgery Center LLC
• Mollie Such
• Tylina Swinger, PHD
• Tempus Ai, Inc.
• Ange Tetsadjio, PHARM.D.
• Rasa Abital Teytel, NP
• Kometh Thawanyarat, BA
• Antoinette Theodore, PA-C

• Dental Clinic/Center in Peachtree Corners, GA
• Providers in Peachtree Corners, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.