1700626835 NPI number — RICCOBENE & ASSOCIATES XIII, DDS, P.A.

Table of content: (NPI 1700626835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700626835 NPI number — RICCOBENE & ASSOCIATES XIII, DDS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICCOBENE & ASSOCIATES XIII, DDS, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700626835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 749625
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-9625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-542-6090
Provider Business Mailing Address Fax Number:
704-981-6177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7940 WILLIAMS POND LN STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277-8413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-542-6090
Provider Business Practice Location Address Fax Number:
704-981-6177
Provider Enumeration Date:
05/28/2024

Additional Information

Authorized Official

Authorized Official Last Name:
RICCOBENE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
855-417-4226

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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