Healthcare Provider Details

I. General information

NPI: 1295567006
Provider Name (Legal Business Name): RICCARDI GENERAL DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 HUDSON ST STE B
AMERICUS GA
31709-3339
US

IV. Provider business mailing address

PO BOX 336
AMERICUS GA
31709-0336
US

V. Phone/Fax

Practice location:
  • Phone: 229-924-2224
  • Fax:
Mailing address:
  • Phone: 229-924-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. NANCY A RICCARDI
Title or Position: SOLE PROPRIETOR
Credential: DMD
Phone: 229-924-2224