=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548348824
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICCOBENE-MCGEES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12330 HIGHWAY 210 SUITE 115
-----------------------------------------------------
City | BENSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-207-2077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12330 HIGHWAY 210 SUITE 115 SUITE 115
-----------------------------------------------------
City | BENSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-207-2077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | TONIA HILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-207-2077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6718
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------