Healthcare Provider Details

I. General information

NPI: 1073189320
Provider Name (Legal Business Name): DAVID E THOME DDS PLLC XI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5708 N SHARON AMITY RD STE 5708A
CHARLOTTE NC
28215-5082
US

IV. Provider business mailing address

8604 CLIFF CAMERON DR STE 170
CHARLOTTE NC
28269-8508
US

V. Phone/Fax

Practice location:
  • Phone: 980-729-5200
  • Fax:
Mailing address:
  • Phone: 980-729-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DAVID EUGENE THOME
Title or Position: OWNER/DENTIST
Credential:
Phone: 980-729-5200