NPIMap

Organization Active NPI

Riccobene & Associates I, DDS, P.a.

  • General Practice Dentistry
  • Bolivia, NC
National Provider Identifier
1023616596
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
RICCOBENE & ASSOCIATES I, DDS, P.A.
Practice address
2831 Midway Rd SE Ste 116
Bolivia, NC 28422-8377
Phone
(910) 408-4436
NPI assigned
Oct 15, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Riccobene
Title
Owner
Phone
(919) 853-6172

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2831 Midway Rd SE Ste 116
Bolivia, NC 28422-8377

Mailing address

PO Box 749625
Atlanta, GA 30374-9625

Other names 1

  • Riccobene Associates Family Dentistry- Southport Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Riccobene Associates I DDS PA35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Locations

2831 Midway Rd SE
Ste 116
Bolivia, NC 28422
Phone (910) 408-4436

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700092800000",
    "number": "1023616596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749625",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2831 MIDWAY RD SE STE 116",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284228377",
            "telephone_number": "910-408-4436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICCOBENE & ASSOCIATES I, DDS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-15",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A",
        "authorized_official_last_name": "RICCOBENE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-853-6172"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riccobene Associates Family Dentistry- Southport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolivia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.