Provider Demographics
NPI:1598463531
Name:DAVID E THOME DDS PLLC L1
Entity Type:Organization
Organization Name:DAVID E THOME DDS PLLC L1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND CONTRACTING COOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-361-9508
Mailing Address - Street 1:8604 CLIFF CAMERON DR STE 170
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8508
Mailing Address - Country:US
Mailing Address - Phone:704-361-9508
Mailing Address - Fax:
Practice Address - Street 1:221 SIMPSON PARK RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4299
Practice Address - Country:US
Practice Address - Phone:704-484-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty