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General NPI Number Information
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NPI Number | 1730862947
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Entity Type | Organization
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Legal Business Name | RICCOBENE & ASSOCIATES CCC, DDS, PC
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 2391 DAVE LYLE BLVD UNIT 101
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City | ROCK HILL
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State | SC
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Zip | 29730-8238
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Country | US
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Telephone | 803-992-8283
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Fax | 864-729-3757
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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 | 803-992-8283
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Fax | 864-729-3757
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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