Provider Demographics
NPI: | 1235346834 |
---|---|
Name: | DAVID E. THOME, D.D.S., P.A. |
Entity type: | Organization |
Organization Name: | DAVID E. THOME, D.D.S., P.A. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | EUGENE |
Authorized Official - Last Name: | THOME |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 954-644-2332 |
Mailing Address - Street 1: | 16223 MIRAMAR PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | MIRAMAR |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33027-4572 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-433-4544 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 16223 MIRAMAR PKWY |
Practice Address - Street 2: | |
Practice Address - City: | MIRAMAR |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33027-4572 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-433-4544 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-16 |
Last Update Date: | 2011-01-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | DN18799 | 1223P0221X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223P0221X | Dental Providers | Dentist | Pediatric Dentistry | Group - Single Specialty |