Healthcare Provider Details

I. General information

NPI: 1336074061
Provider Name (Legal Business Name): NICHOL MARGARET COBURN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8390 CHARLOTTE HWY STE 300
INDIAN LAND SC
29707-6563
US

IV. Provider business mailing address

39 VALLEYVIEW RD
SCENERY HILL PA
15360-1001
US

V. Phone/Fax

Practice location:
  • Phone: 803-431-7477
  • Fax:
Mailing address:
  • Phone: 412-508-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11470
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: