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General NPI Number Information
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NPI Number | 1659151116
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Entity Type | Organization
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Legal Business Name | RICCOBENE & ASSOCIATES CCII, DDS, PC
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 6750 FOREST HILL AVE STE B
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City | RICHMOND
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State | VA
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Zip | 23225-1802
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Country | US
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Telephone | 804-532-4993
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749632
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City | ATLANTA
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State | GA
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Zip | 30374-9632
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Country | US
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Telephone |
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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 | 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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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