Sebastian Bouroncle DDS-1 PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

15L05992 Issued in VA

Legal business name

SEBASTIAN BOURONCLE DDS-1 PLLC

Practice address

1900 Opitz Blvd
Ste C
Woodbridge, VA 22191-3320

Phone

(703) 494-0820

Fax

(703) 499-9430

NPI assigned

Apr 29, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Virginia T De Castro

Title

Office Manager

Phone

(703) 494-0820

Specialties & licenses 1

Addresses

Other names 1

• New Smiles Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yamuna Devi Subramanian, DMD

  • General Practice Dentistry
  • Sterling, VA
  • NPI 1528722477
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430265600000",
    "number": "1740667799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 OPITZ BLVD",
            "address_2": "STE C",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913320",
            "telephone_number": "703-494-0820",
            "fax_number": "703-499-9430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 OPITZ BLVD",
            "address_2": "STE C",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913320",
            "telephone_number": "703-494-0820",
            "fax_number": "703-499-9430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEBASTIAN BOURONCLE DDS-1 PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-29",
        "last_updated": "2015-04-29",
        "status": "A",
        "authorized_official_last_name": "DE CASTRO",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "703-494-0820",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "VA",
            "license": "15L05992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Smiles Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Michelle Schutter, FNP
• Krista M Scofield, PT
• Laia Scott
• Lori Jean Sealy
• Seasons of Hope Center for Grief, Loss and Transition
• Khalidah Sediq
• Ashley Segarra, BCBA
• Ahdal Singh Sekhon
• Emmanuel Owusu Sekyere
• Mercy Amo Sekyere

• Dentist in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.