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NPI Code Detail

MEDICARE: DAVID E THOME DDS PLLC XIV

MEDICARE: DAVID E THOME DDS PLLC XIV
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1588352017
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID E THOME DDS PLLC XIV
Provider Business Mailing Address
First Line : 8604 CLIFF CAMERON DR STE 170
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-8508
Country : US
Telephone Number : 704-885-2637
Fax Number :
Provider Business Practice Location Address
First Line : 8604 CLIFF CAMERON DR STE 170
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-8508
Country : US
Telephone Number : 704-885-2637
Fax Number :
Authorized Official
Title or Position : OWNER/ DENTIST
Name : DR. DAVID E THOME
Credential : DDS
Telephone Number : 704-885-2637
Provider Enumeration Date : 04/24/2023
Last Update Date : 04/24/2023

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