Provider Demographics
NPI:1295567006
Name:RICCARDI GENERAL DENTISTRY, LLC
Entity type:Organization
Organization Name:RICCARDI GENERAL DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICCARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-924-2224
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-0336
Mailing Address - Country:US
Mailing Address - Phone:229-924-2224
Mailing Address - Fax:
Practice Address - Street 1:204 HUDSON ST STE B
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3339
Practice Address - Country:US
Practice Address - Phone:229-924-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty