1124457817 NPI number — DAVID E THOME DDS PLLC II

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124457817 NPI number — DAVID E THOME DDS PLLC II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID E THOME DDS PLLC II
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOORESVILLE PEDIATRIC DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124457817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 746220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-6220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-360-8670
Provider Business Mailing Address Fax Number:
704-360-8675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 WILLIAMSON RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MOORESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28117-7610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-360-8670
Provider Business Practice Location Address Fax Number:
704-360-8675
Provider Enumeration Date:
11/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
LUCENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING & CONTRACTING COORDIN
Authorized Official Telephone Number:
980-729-5200

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com