Platinum Dental Group Lilburn Llc
Pediatric Dental Clinic
609 Beaver Ruin Rd., Ste A, Lilburn
Georgia, 30047
770-709-0000 770-925-3302
Maps & DirectionsPlatinum Dental Group Lilburn Llc is a Pediatric Dental Clinic in Lilburn, Georgia. This organization is also known as sub part of Platinum Dental Group Lilburn Llc. It is located at 609 Beaver Ruin Rd., Ste A, Lilburn, GA and its contact number is 770-709-0000. The authorized person for Platinum Dental Group Lilburn Llc is Mr. Mark Denny Thebaut
who is Owner/dentist of the clinic and their contact number is 678-990-6301. The primary license number for Platinum Dental Group Lilburn Llc is DN009113 (Pediatric Dentistry) in Georgia.
Platinum Dental Group Lilburn Llc Clinic provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Complete Clinic Profile:
Platinum Dental Group Lilburn Llc Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
| Name: | Platinum Dental Group Lilburn Llc |
| Specialization: | Pediatric Dentistry |
| Clinic Address: | 609 Beaver Ruin Rd., Ste A, Lilburn,
Georgia, 30047 |
| Phone: | 770-709-0000 |
| Fax: | 770-925-3302 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
| Name: | Mr. Mark Denny Thebaut |
| Position: | Owner/dentist |
| Contact Number: | 678-990-6301 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for Platinum Dental Group Lilburn Llc clinic are as mentioned below.
| NPI Number: | 1962634543 |
| Parent Organization: | Platinum Dental Group Lilburn Llc |
| NPI Enumeration Date: | 17 Aug, 2009 |
| NPI Last Update On: | 17 Aug, 2009 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Platinum Dental Group Lilburn Llc are as mentioned below.
| Specialization | License Number | State | Status | |
| Pediatric Dentistry | DN009113 | Georgia | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers of the clinic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 151700972B | Medicaid | Georgia | |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Platinum Dental Group Lilburn Llc
Po Box 1953,
Lilburn, Georgia |
| Zip: | 30048-1953 |
| Phone Number: | 770-709-0000 |
| Fax Number: | 770-925-3302 |
Patients can reach Platinum Dental Group Lilburn Llc at
609 Beaver Ruin Rd., Ste A, Lilburn, Georgia or can
call to book an appointment on 770-709-0000.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.