Provider Demographics
NPI:1164894937
Name:RICCOBENE & ASSOCIATES XIII, DDS, P.A.
Entity Type:Organization
Organization Name:RICCOBENE & ASSOCIATES XIII, DDS, P.A.
Other - Org Name:BRUSH AND FLOSS PEDIATRIC DENTISTRY - GARNER
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 749625
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9625
Mailing Address - Country:US
Mailing Address - Phone:919-585-5205
Mailing Address - Fax:
Practice Address - Street 1:5638 NC HIGHWAY 42 W STE 109
Practice Address - Street 2:SUITE 109
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7998
Practice Address - Country:US
Practice Address - Phone:919-772-1463
Practice Address - Fax:866-334-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty