Healthcare Provider Details

I. General information

NPI: 1811985807
Provider Name (Legal Business Name): DAVID E THOME DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 WILLIAMSON RD SUITE 200
MOORESVILLE NC
28117-7610
US

IV. Provider business mailing address

202 WILLIAMSON RD SUITE 200
MOORESVILLE NC
28117-7610
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN18799
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: