Provider Demographics
NPI:1750011243
Name:RICCOBENE & ASSOCIATES CCI, DDS, PC
Entity Type:Organization
Organization Name:RICCOBENE & ASSOCIATES CCI, DDS, PC
Other - Org Name:COMMONWEALTH ORTHODONTICS MIDLOTHIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNEER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCOBENE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-746-9708
Mailing Address - Street 1:3434 KILDAIRE FARM RD STE 350
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-2205
Mailing Address - Country:US
Mailing Address - Phone:330-687-5944
Mailing Address - Fax:
Practice Address - Street 1:6657 LAKE HARBOUR DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2082
Practice Address - Country:US
Practice Address - Phone:804-739-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty