Provider Demographics
NPI:1346784089
Name:RICCOBENE & ASSOCIATES I, DDS, P.A.
Entity Type:Organization
Organization Name:RICCOBENE & ASSOCIATES I, DDS, P.A.
Other - Org Name:RICCOBENE ASSOCIATES FAMILY DENTISTRY- DURHAM
Other - Org Type:Doing Business As
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:
Authorized Official - Phone:910-853-6172
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 1:1125 W NC HIGHWAY 54
Practice Address - Street 2:SUITE 807
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5715
Practice Address - Country:US
Practice Address - Phone:919-975-0626
Practice Address - Fax:866-412-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty