Healthcare Provider Details

I. General information

NPI: 1447328430
Provider Name (Legal Business Name): RICHARD D FIORUCCI DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 BELLE HAVEN RD
ALEXANDRIA VA
22307-1201
US

IV. Provider business mailing address

1451 BELLE HAVEN RD SUITE 310
ALEXANDRIA VA
22307
US

V. Phone/Fax

Practice location:
  • Phone: 703-768-1188
  • Fax:
Mailing address:
  • Phone: 703-768-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberVA4085
License Number StateVA

VIII. Authorized Official

Name: DR. RICHARD D FIORUCCI
Title or Position: ORAL MAXILLOFACIAL SURGEON
Credential: DDS ORAL SURGEON
Phone: 703-768-1188