Healthcare Provider Details

I. General information

NPI: 1255316360
Provider Name (Legal Business Name): HERMAN BRYAN COBB D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 OAKCREST AVE BLDG A
GREENSBORO NC
27408-1934
US

IV. Provider business mailing address

210 STAUNTON DR
GREENSBORO NC
27410-6065
US

V. Phone/Fax

Practice location:
  • Phone: 336-288-9445
  • Fax: 336-288-9491
Mailing address:
  • Phone: 336-292-5912
  • Fax: 336-288-9491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4331
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberNC 4331
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: