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General NPI Number Information
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NPI Number | 1861534950
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Entity Type | Organization
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Legal Business Name | PATTY,LYBRAND & RICCIUTTI DDS PA
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 10801 WOODLAND BEAVER RD STE 103
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City | CHARLOTTE
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State | NC
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Zip | 28215-5177
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Country | US
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Telephone | 704-291-7333
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Fax |
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Provider Business Mailing Address
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Address Line | 1851 WELLNESS BLVD
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City | MONROE
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State | NC
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Zip | 28110-7774
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Country | US
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Telephone | 704-291-7333
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Fax | 704-292-1203
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL / OFFICE MANAGE
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Name | SUSAN GRIFFIN
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Credential |
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Telephone | 704-291-7333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5322
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License Number State | NC
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