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General NPI Number Information
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NPI Number | 1316622491
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Entity Type | Organization
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Legal Business Name | RICCOBENE & ASSOCIATES XIII, DDS, P.A.
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 301 S WILLIS DR STE 100
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City | SHALLOTTE
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State | NC
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Zip | 28470-3445
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Country | US
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Telephone | 910-754-7700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749625
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City | ATLANTA
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State | GA
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Zip | 30374-9625
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Country | US
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Telephone | 910-754-7700
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL RICCOBENE
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Credential |
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Telephone | 855-417-4226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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