# WELSTEAD & ROSINSKI LLC DBA THE LEESBURG DENTISTS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fuller & Spencer Fuller PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215028303
- **Authorized official:** LLEWELLYN WELSREAD DDS (OWNER)
- **Authorized official phone:** (703) 771-8500

## Contact information

- **Practice address:** 706 S. KING STREET, SUITE 5, LEESBURG, VA 20175
- **Practice address phone:** (703) 771-8500
- **Practice address fax:** (703) 771-9541
- **Mailing address:** 706 S. KING STREET, SUITE 5, LEESBURG, VA 20175
- **Mailing address phone:** (703) 771-8500
- **Mailing address fax:** (703) 771-9541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | VA0401006762 | VA | — |
| 122300000X | Dentist | VA0401006767 | VA | Yes |
| 122300000X | Dentist | VA0401008876 | VA | — |

## Other

- **Enumeration date:** 09/27/2006
- **Last updated:** 11/10/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 078792 | BCBS INS PROVIDER | VA |
| 01 | — | 541465992 | DELTA INS PROVIDER | VA |