Provider Demographics
NPI:1215023825
Name:LABRIOLA, J DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:DANIEL
Last Name:LABRIOLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 LITTLE RIVER TURNPIKE
Mailing Address - Street 2:SUITE #101-E
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-256-2307
Mailing Address - Fax:703-256-3230
Practice Address - Street 1:7611 LITTLE RIVER TURNPIKE
Practice Address - Street 2:SUITE #101-E
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-256-2307
Practice Address - Fax:703-256-3230
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010054191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01577J01Medicare PIN
VAT-30976Medicare UPIN