Provider Demographics
NPI:1497816581
Name:SHARON J COBHAM DDS NICOLE LECANN DDS & ASSOC PA
Entity Type:Organization
Organization Name:SHARON J COBHAM DDS NICOLE LECANN DDS & ASSOC PA
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:DDS
Authorized Official - Phone:919-789-8682
Mailing Address - Street 1:4814 SIX FORKS ROAD
Mailing Address - Street 2:SUITE 102 ATTN DR LECANN
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-783-5550
Mailing Address - Fax:919-791-1990
Practice Address - Street 1:1001 W WILLIAMS ST SUITE 101
Practice Address - Street 2:APEX MEDICAL PARK
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502
Practice Address - Country:US
Practice Address - Phone:919-303-2887
Practice Address - Fax:919-363-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
69701223G0001X
70001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016H9Medicaid
NC016H9OtherNCHC