Provider Demographics
NPI:1245393313
Name:SHARON J. COBHAM, DDS, PA, V
Entity Type:Organization
Organization Name:SHARON J. COBHAM, DDS, PA, V
Other - Org Name:SHARON JOVANNA COBHAM DDS, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:JOVANNA
Authorized Official - Last Name:COBHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-412-1033
Mailing Address - Street 1:2728 ANN ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5111
Mailing Address - Country:US
Mailing Address - Phone:336-586-1919
Mailing Address - Fax:336-586-1990
Practice Address - Street 1:2912 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4010
Practice Address - Country:US
Practice Address - Phone:336-765-8940
Practice Address - Fax:336-765-7184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906747Medicaid