Provider Demographics
NPI:1952409401
Name:STEVEN C. RICCI, D.D.S., M.S., P.C.
Entity Type:Organization
Organization Name:STEVEN C. RICCI, D.D.S., M.S., P.C.
Other - Org Name:RICCI ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:678-417-9848
Mailing Address - Street 1:10475 MEDLOCK BRIDGE RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4433
Mailing Address - Country:US
Mailing Address - Phone:678-417-9848
Mailing Address - Fax:678-417-9694
Practice Address - Street 1:10475 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4433
Practice Address - Country:US
Practice Address - Phone:678-417-9848
Practice Address - Fax:678-417-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0119081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty