Provider Demographics
NPI:1346929262
Name:RICCOBENE & ASSOCIATES CC, DDS, PC
Entity Type:Organization
Organization Name:RICCOBENE & ASSOCIATES CC, DDS, PC
Other - Org Name:
Other - Org Type:
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 1:325 FOUR LEAF LN STE 10
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-9203
Mailing Address - Country:US
Mailing Address - Phone:434-823-2290
Mailing Address - Fax:
Practice Address - Street 1:325 FOUR LEAF LN STE 10
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-9203
Practice Address - Country:US
Practice Address - Phone:434-823-2290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty