MEDICARE: RICCOBENE & ASSOCIATES I, DDS, P.A.

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	261QD0000X	Dental Clinic/Center
2	1223G0001X	General Practice Dentistry	6718	NC

General Provider Information

NPI Number	:	1194801852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICCOBENE & ASSOCIATES I, DDS, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 749625
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-9625
Country	:	US
Telephone Number	:	919-550-5251
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 OLEANDER DRIVE
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527
Country	:	US
Telephone Number	:	919-550-5251
Fax Number	:	888-981-3708

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL RICCOBENE
Credential	:
Telephone Number	:	855-417-4226

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	10/19/2023

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