# SEBASTIAN BOURONCLE DDS-1 PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** New Smiles Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740667799
- **Authorized official:** MRS. VIRGINIA T DE CASTRO (OFFICE MANAGER)
- **Authorized official phone:** (703) 494-0820

## Contact information

- **Practice address:** 1900 OPITZ BLVD, STE C, WOODBRIDGE, VA 22191-3320
- **Practice address phone:** (703) 494-0820
- **Practice address fax:** (703) 499-9430
- **Mailing address:** 1900 OPITZ BLVD, STE C, WOODBRIDGE, VA 22191-3320
- **Mailing address phone:** (703) 494-0820
- **Mailing address fax:** (703) 499-9430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 15L05992 | VA | Yes |

## Other

- **Enumeration date:** 04/29/2015
- **Last updated:** 04/29/2015