Provider Demographics
NPI:1427526516
Name:RICCIARDONE FAMILY DENTISTRY
Entity type:Organization
Organization Name:RICCIARDONE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCIARDONE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-342-6672
Mailing Address - Street 1:5300 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-2331
Mailing Address - Country:US
Mailing Address - Phone:251-342-6672
Mailing Address - Fax:251-342-6703
Practice Address - Street 1:5300 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-2331
Practice Address - Country:US
Practice Address - Phone:251-342-6672
Practice Address - Fax:251-342-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental