Provider Demographics
NPI:1225425465
Name:INTEGRATIVE IMPLANT SERVICES, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE IMPLANT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEUXS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:703-388-2889
Mailing Address - Street 1:6845 ELM. STREET
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3834
Mailing Address - Country:US
Mailing Address - Phone:703-388-2889
Mailing Address - Fax:703-388-0669
Practice Address - Street 1:6845 ELM. ST.
Practice Address - Street 2:STE. 225
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3834
Practice Address - Country:US
Practice Address - Phone:703-388-2889
Practice Address - Fax:703-388-0669
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATIVE ORAL SURGEONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-24
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA040142450261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery