| NPI | 1821862186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL RICCOBENE CEO 910-853-6172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2024-08-02 |