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General NPI Number Information
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NPI Number | 1831497809
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Entity Type | Organization
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Legal Business Name | SUMMIT AVENUE COSMETIC AND SEDATION DENTAL CARE
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 714 SUMMIT AVE
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City | GREENSBORO
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State | NC
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Zip | 27405-7832
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Country | US
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Telephone | 336-275-5905
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Fax | 336-273-0110
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Provider Business Mailing Address
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Address Line | 714 SUMMIT AVE
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City | GREENSBORO
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State | NC
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Zip | 27405-7832
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Country | US
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Telephone | 336-275-5905
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Fax | 336-273-0110
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Authorized Official
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Title or Position | DOCTOR
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Name | MS. SHARON JAVONNAH COBHAM
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Credential | DDS
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Telephone | 336-275-5905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6970
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License Number State | NC
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