Provider Demographics
NPI:1821862186
Name:RICCOBENE & ASSOCIATES CCII, DDS, PC
Entity Type:Organization
Organization Name:RICCOBENE & ASSOCIATES CCII, 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:PO BOX 749632
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9632
Mailing Address - Country:US
Mailing Address - Phone:804-621-7631
Mailing Address - Fax:
Practice Address - Street 1:2930 W HUNDRED RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-2126
Practice Address - Country:US
Practice Address - Phone:804-621-7631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty