Provider Demographics
NPI:1780363606
Name:RICCOBENE & ASSOCIATES CC, DDS, PC
Entity type:Organization
Organization Name:RICCOBENE & ASSOCIATES CC, DDS, PC
Other - Org Name:<UNAVAIL>
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:910-853-6172
Mailing Address - Street 1:11201 W HUGUENOT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3334
Mailing Address - Country:US
Mailing Address - Phone:804-320-6800
Mailing Address - Fax:
Practice Address - Street 1:11201 W HUGUENOT RD STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-3334
Practice Address - Country:US
Practice Address - Phone:804-320-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty