MEDICARE: RICCOBENE & ASSOCIATES CC, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1073292900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICCOBENE & ASSOCIATES CC, DDS, PC

Provider Business Mailing Address
First Line	:	PO BOX 749632
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-9632
Country	:	US
Telephone Number	:	804-915-1440
Fax Number	:

Provider Business Practice Location Address
First Line	:	8120 PLEASANT GROVE RD STE 200
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2343
Country	:	US
Telephone Number	:	804-915-1440
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL RICCOBENE
Credential	:
Telephone Number	:	910-853-6172

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	08/02/2024

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