Ricuccio A. Negom, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

55065 Issued in CA

Practice address

735 Tank Farm Rd Ste 170
San Luis Obispo, CA 93401-7071

Phone

(805) 549-9000

Fax

(805) 549-9004

NPI assigned

Nov 7, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ricuccio a. Negom DDS, a Professioal Dental Corporation

  • Dental Clinic/Center
  • San Luis Obispo, CA
  • NPI 1134399892
  NPD Authorized official

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615507200000",
    "number": "1124208152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 TANK FARM RD STE 170",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017071",
            "telephone_number": "805-549-9000",
            "fax_number": "661-951-9847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 TANK FARM RD STE 170",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017071",
            "telephone_number": "805-549-9000",
            "fax_number": "805-549-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEGOM",
        "first_name": "RICUCCIO",
        "middle_name": "A.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-07",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "55065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Nava
• Lisette Navarro
• Mary M Nave, M.D.
• Giseli Moreno Nazmi, CNM
• Petrus G Neethling
• Phillip Negrete, PT
• Scott R Negri, MD
• Dana Bruce Nelson, RPH
• Danielle Nelson
• Eric H Nelson, P.T.

• Dentist in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.