Healthcare Provider Details

I. General information

NPI: 1124457817
Provider Name (Legal Business Name): DAVID E THOME DDS PLLC II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 WILLIAMSON RD SUITE 200
MOORESVILLE NC
28117-7610
US

IV. Provider business mailing address

PO BOX 746220
ATLANTA GA
30374-6220
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-8670
  • Fax: 704-360-8675
Mailing address:
  • Phone: 704-360-8670
  • Fax: 704-360-8675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LUCENDA HARRIS
Title or Position: CREDENTIALING & CONTRACTING COORDIN
Credential:
Phone: 980-729-5200