MEDICARE: DR. LARRY WAYNE COBB D.M.D.

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	2165	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831156777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY WAYNE COBB D.M.D.

Provider Business Mailing Address
First Line	:	2C CLEVELAND CT
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-2414
Country	:	US
Telephone Number	:	864-271-9990
Fax Number	:	864-235-7959

Provider Business Practice Location Address
First Line	:	2C CLEVELAND CT
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-2414
Country	:	US
Telephone Number	:	864-271-9990
Fax Number	:	864-235-7959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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