=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215023825
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | J DANIEL LABRIOLA D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 01/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7611 LITTLE RIVER TURNPIKE SUITE #101-E
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-256-2307
-----------------------------------------------------
Fax | 703-256-3230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7611 LITTLE RIVER TURNPIKE SUITE #101-E
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-256-2307
-----------------------------------------------------
Fax | 703-256-3230
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 0401005419
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------