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General NPI Number Information
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NPI Number | 1073243580
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Entity Type | Organization
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Legal Business Name | RICCOBENE & ASSOCIATES CCI, DDS, PC
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 456 CHARLES H DIMMOCK PKWY STE 9
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2936
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Country | US
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Telephone | 804-520-7292
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Fax |
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Provider Business Mailing Address
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Address Line | 456 CHARLES H DIMMOCK PKWY STE 9
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2936
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Country | US
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Telephone | 804-520-7292
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL RICCOBENE
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Credential | DDS
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Telephone | 910-853-6172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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