1700948767 NPI number — SHARON COBHAM,D.D.S. & NICOLE LECANN, D.D.S.,V,P.A.

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 1700948767 NPI number — SHARON COBHAM,D.D.S. & NICOLE LECANN, D.D.S.,V,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON COBHAM,D.D.S. & NICOLE LECANN, D.D.S.,V,P.A.
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:
Provider Other Organization Name Type Code:
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:
1700948767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4814 SIX FORKS ROAD
Provider Second Line Business Mailing Address:
SUITE 102 ATTN DR LECANN
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-783-5550
Provider Business Mailing Address Fax Number:
919-791-1990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3608 UNIVERSITY DR.
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707-6260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-688-4100
Provider Business Practice Location Address Fax Number:
919-688-4333
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LECANN
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
919-789-8682

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6970 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 7000 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 013E7 . This is a "NCHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89013E7 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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