MEDICARE: DR. RICHARD DONALD FIORUCCI DDS

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)	4085	VA

General Provider Information

NPI Number	:	1700991171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD DONALD FIORUCCI DDS

Provider Business Mailing Address
First Line	:	8823 FIRCREST PL.
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22308
Country	:	US
Telephone Number	:	703-780-9118
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	10/26/2007

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