Provider Demographics
NPI:1154497501
Name:RICCARDI, VICTOR L (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:L
Last Name:RICCARDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PIEDMONT CTR NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1515
Mailing Address - Country:US
Mailing Address - Phone:404-262-1456
Mailing Address - Fax:404-262-7944
Practice Address - Street 1:6 PIEDMONT CTR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1515
Practice Address - Country:US
Practice Address - Phone:404-262-1456
Practice Address - Fax:404-262-7944
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GABR9714014OtherDEA