Organization
SEBASTIAN BOURONCLE DDS-1 PLLC
Active
Other names
New Smiles Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIRGINIA T DE CASTRO (OFFICE MANAGER)
(703) 494-0820
Entity
Organization
Contact information
Practice address
1900 OPITZ BLVD, STE C, WOODBRIDGE, VA 22191-3320
(703) 494-0820
(703) 499-9430
Mailing address
1900 OPITZ BLVD, STE C, WOODBRIDGE, VA 22191-3320
(703) 494-0820
(703) 499-9430
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15L05992
VA
Other
Enumeration date
04/29/2015
Last updated
04/29/2015
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