Healthcare Provider Details

I. General information

NPI: 1497481618
Provider Name (Legal Business Name): DAVID E THOME DDS PLLC I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 CRESSWIND BLVD SUITE 104
CHARLOTTE NC
28215
US

IV. Provider business mailing address

9055 CRESSWIND BLVD SUITE 104
CHARLOTTE NC
28215
US

V. Phone/Fax

Practice location:
  • Phone: 704-350-2152
  • Fax:
Mailing address:
  • Phone: 704-350-2152
  • 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: LUCENDA HARRIS
Title or Position: CREDENTIALING AND CONTRACTING COORD
Credential:
Phone: 980-729-5200