Tebo Dentistry For Kids Peachtree Corners, LLC
Clinic/Center, Dental in Peachtree Corners, GA. Organization (NPI-2).
NPI number1083172035
StatusActive
Last updated in NPPESJun 11, 2019
Details
- NPI
- 1083172035
- Entity type
- Organization (NPI-2)
- Legal business name
- Tebo Dentistry For Kids Peachtree Corners, LLC
- Organization subpart
- No
- Enumeration date
- Mar 8, 2019
- Last updated
- Jun 11, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Other names
- Tebo Dentistry For Kids Peachtree Corners (Doing Business As)
Practice location
6460 Spalding DriveSuite C
Peachtree Corners, GA 30092
Phone 770-925-3300
Mailing address
Po Box 1953Lilburn, GA 30048
Authorized official
Mark Thebaut
President/Owner
7709253300
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