Provider Demographics
NPI:1659151116
Name:RICCOBENE & ASSOCIATES CCII, DDS, PC
Entity Type:Organization
Organization Name:RICCOBENE & ASSOCIATES CCII, DDS, PC
Other - Org Name:COMMONWEALTH SPECIALTY - FOREST HILL
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 1:6750 FOREST HILL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6750 FOREST HILL AVE STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1802
Practice Address - Country:US
Practice Address - Phone:804-532-4993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty