MEDICARE: RICHARD D FIORUCCI DDS LTD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	VA4085	VA

General Provider Information

NPI Number	:	1447328430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD D FIORUCCI DDS LTD

Provider Business Mailing Address
First Line	:	1451 BELLE HAVEN RD
Second Line	:	SUITE 310
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307
Country	:	US
Telephone Number	:	703-768-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	1451 BELLE HAVEN RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-1201
Country	:	US
Telephone Number	:	703-768-1188
Fax Number	:

Authorized Official
Title or Position	:	ORAL MAXILLOFACIAL SURGEON
Name	:	DR. RICHARD D FIORUCCI
Credential	:	DDS ORAL SURGEON
Telephone Number	:	703-768-1188

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	11/26/2007

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