Provider Demographics
NPI:1801521471
Name:DAVID E THOME DDS PLLC I
Entity type:Organization
Organization Name:DAVID E THOME DDS PLLC I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND CONTRACTING COORD
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 1:2301 S CANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6907
Mailing Address - Country:US
Mailing Address - Phone:704-925-8221
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:704-925-8221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty