Provider Demographics
NPI:1609248251
Name:RICCOBENE & ASSOCIATES XIII, DDS, P.A.
Entity Type:Organization
Organization Name:RICCOBENE & ASSOCIATES XIII, DDS, P.A.
Other - Org Name:BRUSH AND FLOSS SPECIALTY- KNIGHTDALE
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 1:1001 WIDEWATERS PKWY
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6102
Practice Address - Country:US
Practice Address - Phone:919-261-7220
Practice Address - Fax:866-460-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty