MEDICARE: DAVID E THOME DDS PLLC L1

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
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1982302915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID E THOME DDS PLLC L1

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	:	704-361-9508
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 WILLIAMSON RD STE 200
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-7611
Country	:	US
Telephone Number	:	704-360-8670
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING AND CONTRACTING COORD
Name	:	LUCENDA HARRIS
Credential	:
Telephone Number	:	704-361-9508

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	02/20/2023

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