# SEBASTIAN M BOURONCLE DDS4 FREDERICKSBURG PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SEBASTIAN M BOURONCLE DDS4 FREDERICKSBURG PLLC
- **Other names:** New Smiles Dental Fredericksburg
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1811770472
- **Legal business name:** SEBASTIAN M BOURONCLE DDS4 FREDERICKSBURG PLLC
- **Authorized official:** DR. SEBASTIAN M BOURONCLE DDS (DENTIST OWNER)
- **Authorized official phone:** (540) 898-1747

## Contact information

- **Practice address:** 11111 LEAVELLS RD, FREDERICKSBURG, VA 22407-5015
- **Practice address phone:** (540) 898-1747
- **Mailing address:** 11111 LEAVELLS RD, FREDERICKSBURG, VA 22407-5015
- **Mailing address phone:** (540) 898-1747

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/17/2023
- **Last updated:** 08/17/2023