Provider Demographics
NPI:1689387771
Name:RICCI ORTHODONTIC STUDIO LLC
Entity Type:Organization
Organization Name:RICCI ORTHODONTIC STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:GUTIERREZ
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:305-773-8035
Mailing Address - Street 1:4320 NW 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5694
Mailing Address - Country:US
Mailing Address - Phone:305-773-8035
Mailing Address - Fax:
Practice Address - Street 1:7950 NW 53RD ST UNIT 126-127
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4653
Practice Address - Country:US
Practice Address - Phone:305-847-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty