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Organization
RICCOBENE & ASSOCIATES XXXVI, DDS, P.A.
Active
Organization
RICCOBENE & ASSOCIATES XXXVI, DDS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SADE RENEE KEITH (CREDENTIALING SPECIALIST)
(919) 238-6833
Entity
Organization
Contact information
Practice address
2250 SHIPYARD BLVD STE 14, WILMINGTON, NC 28403-8070
(910) 392-9101
Mailing address
2250 SHIPYARD BLVD STE 14, WILMINGTON, NC 28403-8070
(910) 392-9101
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
NULL
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
NULL
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
NULL
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
NULL
1223P0700X
Prosthodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
10/15/2019
Last updated
06/15/2021
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