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900 Highway 17 N Ste E North Myrtle Beach SC 29582-2804 | |
(843) 491-6021 | |
Not Available |
Full Name | |
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Speciality | Dentist - Oral And Maxillofacial Surgery |
Location | 900 Highway 17 N Ste E, North Myrtle Beach, South Carolina |
Authorized Official Name and Position | Michael Riccobene (CEO) |
Authorized Official Contact | 8554174226 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 749625 Atlanta GA 30374-9625 Ph: (910) 853-6172 | 900 Highway 17 N Ste E North Myrtle Beach SC 29582-2804 Ph: (843) 491-6021 |
NPI Number | 1205615341 |
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Provider Enumeration Date | 09/27/2023 |
Last Update Date | 11/29/2023 |
Identifier | Type | State | Issuer |
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1205615341 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
Riesenberg Family Dental, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 512 Highway 17 N, North Myrtle Beach, SC 29582 Phone: 843-580-1917 | |