NPIMap

Organization Active NPI

Platinum Dental of Gainesville

  • Pediatric Dentistry
  • Gainesville, GA
National Provider Identifier
1427178201
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
9113 Issued in GA
Legal business name
PLATINUM DENTAL OF GAINESVILLE
Practice address
3535 Thompson Bridge Rd
Gainesville, GA 30506-1551
Phone
(770) 534-5374
Fax
(770) 534-5591
NPI assigned
Mar 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Dr. Mark D Thebaut, DDS
Title
Owner
Phone
(770) 534-5374

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 9113 GA
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 9113 GA Primary

Addresses

Primary practice location

3535 Thompson Bridge Rd
Gainesville, GA 30506-1551

Mailing address

3535 Thompson Bridge Rd
Gainesville, GA 30506-1551
Phone (770) 534-5374

Other names 1

  • Platinum Dental Gainesville, LLC Doing business as

National Provider Directory

National Provider Directory
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.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1427178201",
    "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": "305061551",
            "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": "305061551",
            "telephone_number": "770-534-5374",
            "fax_number": "770-534-5591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATINUM DENTAL OF GAINESVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "THEBAUT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-534-5374",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "9113",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "9113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Platinum Dental Gainesville, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.