Patty,Lybrand & Ricciutti DDS PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

5322 Issued in NC

Legal business name

PATTY,LYBRAND & RICCIUTTI DDS PA

Practice address

10801 Woodland Beaver Rd Ste 103
Charlotte, NC 28215-5177

Phone

(704) 291-7333

NPI assigned

Feb 13, 2007

Last updated

May 7, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susan Griffin

Title

Authorized Official / Office Manage

Phone

(704) 291-7333

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelley Suzanne Lybrand, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Monroe, NC
  • NPI 1265515399
  NPD (past)
• Erik F Reitter, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Monroe, NC
  • NPI 1740299569
  NPD (past)
• Jesse Eric Ricciuti, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Monroe, NC
  • NPI 1003296831
  NPD (past)
• Tara Anne Valiquette, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Monroe, NC
  • NPI 1295931020
  NPD (past)

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1861534950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1851 WELLNESS BLVD",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281107774",
            "telephone_number": "704-291-7333",
            "fax_number": "704-292-1203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10801 WOODLAND BEAVER RD STE 103",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282155177",
            "telephone_number": "704-291-7333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1851 Wellness Blvd",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "NC",
            "postal_code": "281107774",
            "country_code": "US",
            "telephone_number": "704-291-7333",
            "fax_number": "704-292-1203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PATTY,LYBRAND & RICCIUTTI DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL / OFFICE MANAGE",
        "authorized_official_telephone_number": "704-291-7333"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "5322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8996674",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INS",
            "identifier": "583212",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIGON BCBS INS",
            "identifier": "328400",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD NC",
            "identifier": "96674",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZN5322",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordyn Patton, MSW, LCSWA
• Joylena Patton
• Sarah Patton, RD
• Sergio Patton, MD
• Zariona Patton
• Vinay Anil Patwardhan
• Fern E Paul-Aviles, PHARMD
• Antoinette Perry Paul, FNP-C
• Barry Adam Paul, MD
• Ciandra Paul

• Oral and Maxillofacial Surgery (Dentist) in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; 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.