Organization
PATTY,LYBRAND & RICCIUTTI DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN GRIFFIN (AUTHORIZED OFFICIAL / OFFICE MANAGE)
(704) 291-7333
Entity
Organization
Contact information
Practice address
10801 WOODLAND BEAVER RD STE 103, CHARLOTTE, NC 28215-5177
(704) 291-7333
Mailing address
1851 WELLNESS BLVD, MONROE, NC 28110-7774
(704) 291-7333
(704) 292-1203
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5322
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
328400
TRIGON BCBS INS
CO
01
—
583212
UNITED CONCORDIA INS
PA
05
—
8996674
—
NC
01
—
96674
BLUE CROSS BLUE SHIELD NC
NC
05
—
ZN5322
—
SC
Enumeration date
02/13/2007
Last updated
05/07/2024
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