Provider Demographics
NPI:1922555689
Name:DAVID E THOME DDS PLLC V
Entity Type:Organization
Organization Name:DAVID E THOME DDS PLLC V
Other - Org Name:CABARRUS PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING & CONTRACTING COORDIN
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:980-729-5200
Mailing Address - Street 1:PO BOX 530172
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0172
Mailing Address - Country:US
Mailing Address - Phone:980-729-5200
Mailing Address - Fax:
Practice Address - Street 1:2301 S CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6907
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:2016-09-09
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC92771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty