Organization
SEBASTIAN M BOURONCLE DDS-2 STAFFORD PLLC
Active
Other names
New Smiles Dental Stafford
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WENDY TAVARA (OFFICE MANAGER)
(540) 720-1222
Entity
Organization
Contact information
Practice address
450 GARRISONVILLE RD, SUITE# 201, STAFFORD, VA 22554-1532
(540) 720-1222
Mailing address
450 GARRISONVILLE RD, SUITE# 201, STAFFORD, VA 22554-1532
(540) 720-1222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401411466
VA
Other
Enumeration date
12/14/2016
Last updated
12/14/2016
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