=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619418076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID E THOME DDS PLLC VIII
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2017
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 236 MARKET ST SUITE 200
-----------------------------------------------------
City | LOCUST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28097-9438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-604-0353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 236 MARKET ST STE 200
-----------------------------------------------------
City | LOCUST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28097-9439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-354-0784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF CREDENTIALING & PAYER R
-----------------------------------------------------
Name | SONYA MYRICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 980-390-2807
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 9277
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------