MEDICARE: DR. DONALD J. DENUCCI D.D.S.

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	1223P0300X	Periodontics	11291	MD
2	1223P0300X	Periodontics	5000760-015	WI

General Provider Information

NPI Number	:	1780618967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD J. DENUCCI D.D.S.

Provider Business Mailing Address
First Line	:	10925 CITREON CT
Second Line	:
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-2527
Country	:	US
Telephone Number	:	301-340-0949
Fax Number	:

Provider Business Practice Location Address
First Line	:	10925 CITREON CT
Second Line	:
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-2527
Country	:	US
Telephone Number	:	301-340-0949
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	09/15/2008

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