Healthcare Provider Details

I. General information

NPI: 1942672878
Provider Name (Legal Business Name): RICCOBENE & ASSOCIATES XIII, DDS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 NW MAYNARD ROAD
CARY NC
27513
US

IV. Provider business mailing address

PO BOX 749625
ATLANTA GA
30374-9625
US

V. Phone/Fax

Practice location:
  • Phone: 919-975-0626
  • Fax:
Mailing address:
  • Phone: 919-230-7692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL RICCOBENE
Title or Position: OWNER
Credential:
Phone: 855-417-4226