Healthcare Provider Details

I. General information

NPI: 1851205298
Provider Name (Legal Business Name): RICCOBENE & ASSOCIATES CC, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4572 FRANKLIN RD SW
ROANOKE VA
24014-5144
US

IV. Provider business mailing address

PO BOX 749632
ATLANTA GA
30374-9632
US

V. Phone/Fax

Practice location:
  • Phone: 540-769-5020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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