Platinum Dental Group Gainesville, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PLATINUM DENTAL GROUP GAINESVILLE, LLC

Practice address

3535 Thompson Bridge Rd
Gainesville, GA 30506

Phone

(770) 534-5374

Fax

(770) 534-5591

NPI assigned

Oct 1, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Mark Denny Thebaut, DDS

Title

Owner/Dentist

Phone

(678) 990-6301

Specialties & licenses 2

Addresses

Other identifiers 6

Tax ID family

Platinum Dental Gainesville LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Platinum Dental of Gainesville

  • Pediatric Dentistry
  • Gainesville, GA
  • NPI 1427178201
  NPD tax ID

Locations

Practitioners 1

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

• Stanley Sotnikov, DDS

  • General Practice Dentistry
  • Gainesville, GA
  • NPI 1023110368
  NPD (past)

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

{
    "created_epoch": "1254355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254355200000",
    "number": "1083948491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 THOMPSON BRIDGE RD",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30506",
            "telephone_number": "770-534-5374",
            "fax_number": "770-534-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 THOMPSON BRIDGE RD",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30506",
            "telephone_number": "770-534-5374",
            "fax_number": "770-534-5591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATINUM DENTAL GROUP GAINESVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-01",
        "last_updated": "2009-10-01",
        "status": "A",
        "authorized_official_last_name": "THEBAUT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DENNY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "678-990-6301",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000185875H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232076497C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149199935C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177273740C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151700972D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "591447276D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerrid Pippin, M.D.
• Jeanette Susan Pirkle, APRN, NP-C
• Tania B. Pirkle
• Prabhakar Pisipati, MD
• Olubunmi Titilope Pitan, MD
• Platinum Dental of Gainesville
• Platinum EMS LLC
• Lindsay Platt, PT, DPT
• Darlene McDaniel Plavcan, CNA
• Megan Gil Plemmons, PT, DPT

• Pediatric Dentistry in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; 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.