Provider Demographics
NPI:1043930365
Name:RICCOBENE & ASSOCIATES CC, DDS, PC
Entity Type:Organization
Organization Name:RICCOBENE & ASSOCIATES CC, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCOBENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-439-3331
Mailing Address - Street 1:3434 KILDAIRE FARM RD STE 350
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-2205
Mailing Address - Country:US
Mailing Address - Phone:919-289-1857
Mailing Address - Fax:
Practice Address - Street 1:456 CHARLES H DIMMOCK PKWY STE 9
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2936
Practice Address - Country:US
Practice Address - Phone:804-520-7292
Practice Address - Fax:804-518-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty