Provider Demographics
NPI:1730862947
Name:RICCOBENE & ASSOCIATES CCC, DDS, PC
Entity type:Organization
Organization Name:RICCOBENE & ASSOCIATES CCC, 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:855-417-4226
Mailing Address - Street 1:PO BOX 749625
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9625
Mailing Address - Country:US
Mailing Address - Phone:803-992-8283
Mailing Address - Fax:864-729-3757
Practice Address - Street 1:2391 DAVE LYLE BLVD UNIT 101
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-8238
Practice Address - Country:US
Practice Address - Phone:803-992-8283
Practice Address - Fax:864-729-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty