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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1669328258
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	:	910-375-9579
Fax Number	:

Provider Business Practice Location Address
First Line	:	5021 SOUTHPORT CROSSINGS WAY STE 310
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461
Country	:	US
Telephone Number	:	910-375-9579
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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