MEDICARE: LEANET ASCUNCE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN18365	FL
2	1223P0221X	Pediatric Dentistry	DN18365	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710130661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANET ASCUNCE DMD

Provider Business Mailing Address
First Line	:	3942 CHERRYBROOK LOOP
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-7002
Country	:	US
Telephone Number	:	305-951-9732
Fax Number	:

Provider Business Practice Location Address
First Line	:	PEDIATRIC DENTISTRY OF FORT MYERS
Second Line	:	8016 SUMMERLIN LAKES DR
City	:	FORT MYERS
State	:	FL
Zip	:	33907
Country	:	UM
Telephone Number	:	239-482-2722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	08/03/2015

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