MEDICARE: E LAWRENCE NUCCI DMD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS018578L	PA

General Provider Information

NPI Number	:	1003821463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E LAWRENCE NUCCI DMD PC

Provider Business Mailing Address
First Line	:	4212 OLD WILLIAM PENN HIGHWAY
Second Line	:
City	:	MURRYSVILLE
State	:	PA
Zip	:	15668-1901
Country	:	US
Telephone Number	:	724-327-7778
Fax Number	:	724-327-4497

Provider Business Practice Location Address
First Line	:	4212 OLD WILLIAM PENN HIGHWAY
Second Line	:
City	:	MURRYSVILLE
State	:	PA
Zip	:	15668-1901
Country	:	US
Telephone Number	:	724-327-7778
Fax Number	:	724-327-4497

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. E LAWRENCE NUCCI
Credential	:	DMD
Telephone Number	:	724-327-7778

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	01/03/2013

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