MEDICARE: DR. ERIC FRUSCIANTE D.M.D.

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	DS040220	PA

General Provider Information

NPI Number	:	1265837751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC FRUSCIANTE D.M.D.

Provider Business Mailing Address
First Line	:	920 WYOMING AVE
Second Line	:	SUITE 104
City	:	FORTY FORT
State	:	PA
Zip	:	18704-3953
Country	:	US
Telephone Number	:	570-283-2422
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 WYOMING AVE
Second Line	:	SUITE 104
City	:	FORTY FORT
State	:	PA
Zip	:	18704-3953
Country	:	US
Telephone Number	:	570-283-2422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	10/27/2014

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