Provider Demographics
NPI:1386014876
Name:THOME & HENDRICK DDS PLLC
Entity Type:Organization
Organization Name:THOME & HENDRICK DDS PLLC
Other - Org Name:LOWER CREEK FAMILY DENTISTRY AND CALDWELL PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-604-0353
Mailing Address - Street 1:8303 UNIVERSITY EXEC PARK DR
Mailing Address - Street 2:SUITE 430
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3356
Mailing Address - Country:US
Mailing Address - Phone:704-604-0353
Mailing Address - Fax:
Practice Address - Street 1:1315 WILKESBORO BLVD
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4730
Practice Address - Country:US
Practice Address - Phone:704-604-0353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty