Provider Demographics
NPI:1053545236
Name:SHARON COBHAM,D.D.S.,AND NICOLE LECANN,D.D.S.II, P.A.
Entity type:Organization
Organization Name:SHARON COBHAM,D.D.S.,AND NICOLE LECANN,D.D.S.II, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LECANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-789-8682
Mailing Address - Street 1:4814 SIX FORKS RD STE 102
Mailing Address - Street 2:ATTN: DR. LECANN
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5246
Mailing Address - Country:US
Mailing Address - Phone:919-783-5550
Mailing Address - Fax:919-791-1990
Practice Address - Street 1:3333 BROOKVIEW HILLS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5661
Practice Address - Country:US
Practice Address - Phone:336-768-3084
Practice Address - Fax:336-768-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70001223G0001X
NC69701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty