Healthcare Provider Details

I. General information

NPI: 1407114283
Provider Name (Legal Business Name): DAVID E. THOME, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MAHALEY AVE SUITE B
SALISBURY NC
28144-2449
US

IV. Provider business mailing address

140 MAHALEY AVE SUITE B
SALISBURY NC
28144-2449
US

V. Phone/Fax

Practice location:
  • Phone: 704-637-5506
  • Fax: 704-637-0481
Mailing address:
  • Phone: 704-637-5506
  • Fax: 704-637-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9277
License Number StateNC

VIII. Authorized Official

Name: DAVID E THOME
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 954-644-2332