Provider Demographics
NPI:1780713982
Name:COBB, JAMES LOLLIS JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOLLIS
Last Name:COBB
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 1 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2823
Mailing Address - Country:US
Mailing Address - Phone:864-654-4882
Mailing Address - Fax:864-654-0139
Practice Address - Street 1:602 1 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631
Practice Address - Country:US
Practice Address - Phone:864-654-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3001468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist