| NPI | 1083948491 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2009-10-01 |
| Last Updated | 2009-10-01 |
| Authorized Official | Mark Thebaut Owner/Dentist Phone: 6789906301 |
| Mailing Address | 3535 Thompson Bridge Rd Gainesville, GA 30506 United States Phone: (770) 534-5374 | Fax: (770) 534-5591 📍 View Map |
| Primary Practice Address | 3535 Thompson Bridge Rd Gainesville, GA 30506 United States Phone: (770) 534-5374 | Fax: (770) 534-5591 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| MEDICAID | GA | 000185875H | - |
| MEDICAID | GA | 149199935C | - |
| MEDICAID | GA | 151700972D | - |
| MEDICAID | GA | 177273740C | - |
| MEDICAID | GA | 232076497C | - |
| MEDICAID | GA | 591447276D | - |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| No | 1223G0001X – Dentist, General Practice | - | - |
| Yes | 1223P0221X – Dentist, Pediatric Dentistry | - | - |
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About NPI 1083948491
Platinum Dental Group Gainesville, Llc is an organization registered in the CMS NPPES NPI Registry with NPI number 1083948491. The primary specialty listed is Dentist, Pediatric Dentistry. The organization is located in Gainesville, GA. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2009-10-01. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1083948491?
NPI 1083948491 belongs to Platinum Dental Group Gainesville, Llc, a Dentist, Pediatric Dentistry in Gainesville, GA. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1083948491 active?
The current status of NPI 1083948491 in the NPPES registry is Active. The record was last updated on 2009-10-01.
What specialty is NPI 1083948491?
NPI 1083948491 is classified under the taxonomy Dentist, Pediatric Dentistry. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1083948491?
You can verify NPI 1083948491 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1083948491?
The primary practice address on file for NPI 1083948491 is 3535 Thompson Bridge Rd, Gainesville, GA 30506. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1083948491 issued?
NPI 1083948491 was first issued (enumerated) on 2009-10-01. The NPPES record was last updated on 2009-10-01.
Practice Location Map
Platinum Dental Group Gainesville, Llc is located at 3535 Thompson Bridge Rd, Gainesville, GA. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Platinum Dental Group Gainesville, Llc. All records sourced from the CMS NPPES registry.