Healthcare Provider Details

I. General information

NPI: 1437597853
Provider Name (Legal Business Name): DAVID E THOME DDS PLLC III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MAHALEY AVE
SALISBURY NC
28144-2449
US

IV. Provider business mailing address

PO BOX 746217
ATLANTA GA
30374-6217
US

V. Phone/Fax

Practice location:
  • Phone: 704-637-5506
  • Fax: 704-637-0481
Mailing address:
  • Phone: 980-729-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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