MEDICARE: RICHARD DRUCE, D.D.S., P.A.

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	15527	NJ

General Provider Information

NPI Number	:	1124148853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD DRUCE, D.D.S., P.A.

Provider Business Mailing Address
First Line	:	1 LETHBRIDGE PLZ
Second Line	:	SUITE 8
City	:	MAHWAH
State	:	NJ
Zip	:	07430-2126
Country	:	US
Telephone Number	:	201-529-9044
Fax Number	:	845-342-6011

Provider Business Practice Location Address
First Line	:	1 LETHBRIDGE PLZ
Second Line	:	SUITE 8
City	:	MAHWAH
State	:	NJ
Zip	:	07430-2126
Country	:	US
Telephone Number	:	201-529-9044
Fax Number	:	845-342-6011

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD DRUCE
Credential	:	D.D.S.
Telephone Number	:	201-529-9044

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	10/11/2007

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