| NPI | 1841044385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL RICCOBENE CEO 855-417-4226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223P0700X Dentist Prosthodontics | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| Enumeration Date | 2024-04-12 |
| Last Update Date | 2024-04-12 |