Provider Demographics
NPI:1073292900
Name:RICCOBENE & ASSOCIATES CC, DDS, PC
Entity Type:Organization
Organization Name:RICCOBENE & ASSOCIATES CC, DDS, PC
Other - Org Name:COMMONWEALTH DENTISTRY - MECHANICSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCOBENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-417-4226
Mailing Address - Street 1:PO BOX 749632
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9632
Mailing Address - Country:US
Mailing Address - Phone:804-915-1440
Mailing Address - Fax:
Practice Address - Street 1:8120 PLEASANT GROVE RD STE 200
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2343
Practice Address - Country:US
Practice Address - Phone:804-915-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty