# RICCOBENE & ASSOCIATES XXXVI, DDS, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962044560
- **Authorized official:** SADE RENEE KEITH (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (919) 238-6833

## Contact information

- **Practice address:** 2250 SHIPYARD BLVD STE 14, WILMINGTON, NC 28403-8070
- **Practice address phone:** (910) 392-9101
- **Mailing address:** 2250 SHIPYARD BLVD STE 14, WILMINGTON, NC 28403-8070
- **Mailing address phone:** (910) 392-9101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 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