MEDICARE: RICCOBENE & ASSOCIATES XIII, 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	1223P0221X	Pediatric Dentistry	8980	NC

General Provider Information

NPI Number	:	1265778963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICCOBENE & ASSOCIATES XIII, 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	:	919-585-5205
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 CRESCENT GRN
Second Line	:	SUITE 200
City	:	CARY
State	:	NC
Zip	:	27518-8116
Country	:	US
Telephone Number	:	919-851-0011
Fax Number	:	866-309-2435

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

Provider Enumeration Date	:	12/27/2012
Last Update Date	:	10/19/2023

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