Provider Demographics
NPI:1710130661
Name:ASCUNCE, LEANET (DMD)
Entity Type:Individual
Prefix:
First Name:LEANET
Middle Name:
Last Name:ASCUNCE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3942 CHERRYBROOK LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-7002
Mailing Address - Country:US
Mailing Address - Phone:305-951-9732
Mailing Address - Fax:
Practice Address - Street 1:PEDIATRIC DENTISTRY OF FORT MYERS
Practice Address - Street 2:8016 SUMMERLIN LAKES DR
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:UM
Practice Address - Phone:239-482-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18365122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist