Provider Demographics
NPI:1104383868
Name:RICCOBENE & ASSOCIATES XXVIII, DDS, P.A.
Entity Type:Organization
Organization Name:RICCOBENE & ASSOCIATES XXVIII, DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCOBENE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-439-3331
Mailing Address - Street 1:3416 MELROSE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1610
Mailing Address - Country:US
Mailing Address - Phone:910-853-6201
Mailing Address - Fax:
Practice Address - Street 1:3416 MELROSE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1610
Practice Address - Country:US
Practice Address - Phone:910-853-6201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty