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

Table of content: (NPI 1700948767)

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".




Copyright © 2007-2025 www.npivalidator.com