Provider Demographics
NPI:1902980493
Name:RICCOBENE & ASSOCIATES I, DDS, P.A.
Entity Type:Organization
Organization Name:RICCOBENE & ASSOCIATES I, DDS, P.A.
Other - Org Name:RICCOBENE ASSOCIATES FAMILY DENTISTRY - GARNER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
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 1:5638 NC HIGHWAY 42 W
Mailing Address - Street 2:SUITE 214
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7998
Mailing Address - Country:US
Mailing Address - Phone:919-661-6161
Mailing Address - Fax:919-661-6820
Practice Address - Street 1:5638 NC HIGHWAY 42 W
Practice Address - Street 2:SUITE 214
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7998
Practice Address - Country:US
Practice Address - Phone:919-661-6161
Practice Address - Fax:919-661-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty