Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 28378 | CA |
NPI | 1053453605 |
---|---|
Provider Name | Dr. Frank A Riccoboni |
First Address | Mountain View, CA 94040-4212 |
Second Address | Mountain View, CA 94040-4212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |