| NPI | 1790256782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL RICCOBENE Owner 919-550-5251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology | |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2019-12-31 |