Provider Demographics
NPI:1952593899
Name:A WINK AND A SMILE DENITST PLLC
Entity type:Organization
Organization Name:A WINK AND A SMILE DENITST PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:EUN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:571-333-1250
Mailing Address - Street 1:19369 PROMENADE DR
Mailing Address - Street 2:K102
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6501
Mailing Address - Country:US
Mailing Address - Phone:571-333-1250
Mailing Address - Fax:571-333-1251
Practice Address - Street 1:19369 PROMENADE DR
Practice Address - Street 2:K102
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-6501
Practice Address - Country:US
Practice Address - Phone:571-333-1250
Practice Address - Fax:571-333-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty