MEDICARE: RICHARD DRUCE 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	041058	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1821118647	OTHER	NY	RICHARD DRUCE D.D.S., P.A

General Provider Information

NPI Number	:	1821286378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD DRUCE D.D.S.

Provider Business Mailing Address
First Line	:	419 E MAIN ST
Second Line	:	SUITE 301
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-2552
Country	:	US
Telephone Number	:	845-342-4334
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 E MAIN ST
Second Line	:	SUITE 301
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-2552
Country	:	US
Telephone Number	:	845-342-4334
Fax Number	:

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

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	10/10/2007

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