Healthcare Provider Details

I. General information

NPI: 1154538304
Provider Name (Legal Business Name): SHARON COBHAM DDS NICOLE LECANN DDS & KAREN TORRES DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 W WILLIAMS ST
APEX NC
27523-9315
US

IV. Provider business mailing address

4814 SIX FORKS RD SUITE 102
RALEIGH NC
27609-5246
US

V. Phone/Fax

Practice location:
  • Phone: 919-363-1001
  • Fax: 919-363-1002
Mailing address:
  • Phone: 919-783-5550
  • Fax: 919-791-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6970
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7033
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7000
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. NICOLE LECANN
Title or Position: OWNER
Credential: DDS
Phone: 919-783-5550