Healthcare Provider Details

I. General information

NPI: 1659549772
Provider Name (Legal Business Name): BRYAN COBB DDS,MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 OAKCREST AVE STE A
GREENSBORO NC
27408-1935
US

IV. Provider business mailing address

2600 OAKCREST AVE STE A
GREENSBORO NC
27408-1935
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number4331
License Number StateNC

VIII. Authorized Official

Name: BRYAN COBB
Title or Position: OWNER
Credential: DDS.MS
Phone: 336-288-9445