DR. JESSE ERIC RICCIUTI (NPI# 1003296831) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003296831 |
| Entity Type | Individual |
| Full Name | DR. JESSE ERIC RICCIUTI |
| Credential | DDS |
| Practice Address |
10042 Park Cedar Dr Ste B Charlotte NC 28210 |
| Mailing Address |
10042 Park Cedar Dr Ste B Charlotte NC 28210-8917 |
| Practice Telephone | 7045429600 |
| Practice Fax Number | 7045429651 |
| Mailing Telephone | 7045429600 |
| Mailing Fax Number | 7045429651 |
| Enumeration Date | 2015-06-07 |
| Last Update Date | 2019-09-03 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
9450 | SC | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
11566 | NC | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 10935 Wings Crossing Dr, Ste 400, Charlotte, NC 28273 | 9809391400 | 9809391460 |
| 9787 Charlotte Hwy Ste 100, Fort Mill, SC 297078200 | 8036201420 | 8032284474 |
| 527 S New Hope Rd, Gastonia, NC 280544040 | 7048338700 | 7044644964 |
| Street Address |
10042 PARK CEDAR DR STE B |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952920860 | Rx Care 14 LLC | Pharmacy | 7701 Sharon Lakes Road, Suite H, Charlotte, NC 28210 | 2020-04-10 |
| 1427697622 | David Durant Dinsmore | Nurse Anesthetist, Certified Registered | Atrium Health Pineville, 10628 Park Road, Charlotte, NC 28210 | 2020-01-06 |
| 1790256964 | Tele Phys Inc | Internal Medicine | 10035 Park Center Dr., Ste 100, Charlotte, NC 28210 | 2018-12-16 |
| 1104395896 | Bridgett Williams | Behavior Technician | 7806 Andover Woods Drive, Charlotte, NC 28210 | 2018-11-26 |
| 1053880518 | Low-t Physicians Professional Association | Internal Medicine | 10430 Park Road Suite 100a, Charlotte, NC 28210 | 2018-11-14 |
| 1053895102 | Carolinas Medical Equipment LLC | Durable Medical Equipment & Medical Supplies | 7701 Sharon Lakes Blvd, Ste A., Charlotte, NC 28210 | 2018-09-24 |
| 1679066658 | Afc Urgent Care and Family Care of Wnc, Pllc | Clinic/Center | 10102 Johnston Rd, Charlotte, NC 28210 | 2018-06-13 |
| 1346777018 | Hopeway Foundation | Clinic/Center | 1717 Sharon Road West, Charlotte, NC 28210 | 2017-05-12 |
| 1891154688 | Jessie Lee Ogienko | Social Worker | 5960 Fairview Rd Ste 328, Charlotte, NC 28210 | 2016-02-22 |
| 1699151985 | Carolina Complete Psychiatry, Pllc | Physician Assistant | 5950 Fairview Road, Suite 708, Charlotte, NC 28210 | 2015-08-10 |
| Find all providers in zip 28210 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518346105 | Christopher Abernathy | Dentist | 3111 Springbank Ln Ste A, Charlotte, NC 28226 | 2015-05-28 |
| 1619314556 | George Yi Jaan Soung | Dentist | 5700 University Pointe Blvd Ste 104, Charlotte, NC 28262-5026 | 2013-06-02 |
| 1013278696 | Andrew Henry | Dentist | 8840 Blakeney Professional Dr Ste 300, Charlotte, NC 28277-6749 | 2012-05-31 |
| 1861703183 | Carrie A Baldwin | Dentist | 1601 Abbey Pl Ste 220, Charlotte, NC 28209-3825 | 2010-07-01 |
| 1407011927 | Karthik Kanakasundaram Naidu | Dentist | 5700 University Pointe Blvd, Suite 104, Charlotte, NC 28262-5026 | 2008-07-24 |
| 1861650095 | Mid Michigan Oral Surgery | Dentist | 110 N Cochran Ave, Charlotte, MI 48813-1508 | 2008-05-23 |
| 1942474077 | Waheed V Mohamed | Dentist | 411 Billingsley Rd., Suite 105, Charlotte, NC 28211 | 2008-04-18 |
| 1659543155 | John Omalley | Dentist | 2007 Randolph Rd, Charlotte, NC 28207-1233 | 2008-03-25 |
| 1679756597 | Robert L Seymour Dds Pa | Dentist | 2711 Randolph Rd Ste 510, Charlotte, NC 28207-2027 | 2007-12-13 |
| 1558426874 | John P Omalley Dmd Pa | Dentist | 2007 Randolph Road, Charlotte, NC 28207 | 2006-12-27 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.