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General NPI Number Information
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NPI Number | 1306623939
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Entity Type | Organization
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Legal Business Name | RICCO DENTAL GROUP
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 89 GRAND AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-4905
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Country | US
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Telephone | 516-798-0223
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Fax | 516-798-1970
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Provider Business Mailing Address
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Address Line | 89 GRAND AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-4905
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Country | US
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Telephone | 516-798-0223
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Fax | 516-798-1970
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CATHERINE CREEDON
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Credential |
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Telephone | 516-798-0223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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