Provider Demographics
NPI:1679791198
Name:COBHAM, SHARON JOVANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:JOVANNA
Last Name:COBHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:336-765-8940
Mailing Address - Fax:919-882-8780
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:919-882-8780
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899011FMedicaid