Provider Demographics
NPI:1447328430
Name:RICHARD D FIORUCCI DDS LTD
Entity type:Organization
Organization Name:RICHARD D FIORUCCI DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:FIORUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS ORAL SURGEON
Authorized Official - Phone:703-768-1188
Mailing Address - Street 1:1451 BELLE HAVEN RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307
Mailing Address - Country:US
Mailing Address - Phone:703-768-1188
Mailing Address - Fax:
Practice Address - Street 1:1451 BELLE HAVEN RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-1201
Practice Address - Country:US
Practice Address - Phone:703-768-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA40851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA100664Medicare PIN
VAT30882Medicare UPIN