Healthcare Provider Details

I. General information

NPI: 1598463531
Provider Name (Legal Business Name): DAVID E THOME DDS PLLC L1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 SIMPSON PARK RD
SHELBY NC
28150-4299
US

IV. Provider business mailing address

8604 CLIFF CAMERON DR STE 170
CHARLOTTE NC
28269-8508
US

V. Phone/Fax

Practice location:
  • Phone: 704-484-3366
  • Fax:
Mailing address:
  • Phone: 704-361-9508
  • 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 COOR
Credential:
Phone: 704-361-9508