MEDICARE: SHARON COBHAM,D.D.S. & NICOLE LECANN, D.D.S.,V,P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6970
2	1223G0001X	General Practice Dentistry	7000

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	013E7	OTHER	NC	NCHC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700948767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARON COBHAM,D.D.S. & NICOLE LECANN, D.D.S.,V,P.A.

Provider Business Mailing Address
First Line	:	4814 SIX FORKS ROAD
Second Line	:	SUITE 102 ATTN DR LECANN
City	:	RALEIGH
State	:	NC
Zip	:	27609
Country	:	US
Telephone Number	:	919-783-5550
Fax Number	:	919-791-1990

Provider Business Practice Location Address
First Line	:	3608 UNIVERSITY DR.
Second Line	:	SUITE 104
City	:	DURHAM
State	:	NC
Zip	:	27707-6260
Country	:	US
Telephone Number	:	919-688-4100
Fax Number	:	919-688-4333

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICOLE LECANN
Credential	:	DDS
Telephone Number	:	919-789-8682

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	04/04/2008

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