Healthcare Provider Details

I. General information

NPI: 1699423251
Provider Name (Legal Business Name): RICCOBENE & ASSOCIATES I, DDS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHARLOIS BLVD
WINSTON SALEM NC
27103-1507
US

IV. Provider business mailing address

PO BOX 749625
ATLANTA GA
30374-9625
US

V. Phone/Fax

Practice location:
  • Phone: 336-331-3500
  • Fax: 336-331-3504
Mailing address:
  • Phone: 910-853-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL RICCOBENE
Title or Position: OWNER
Credential:
Phone: 910-853-6172