Provider Demographics
NPI:1760833024
Name:DRS. CHURCH SALAS AND LEIPZIG LLC
Entity Type:Organization
Organization Name:DRS. CHURCH SALAS AND LEIPZIG LLC
Other - Org Name:DENTAL SMILES AT PURCELLVILLE GATEWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARMENTROUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-338-3330
Mailing Address - Street 1:100 PURCELLVILLE GATEWAY DR
Mailing Address - Street 2:STE D
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3486
Mailing Address - Country:US
Mailing Address - Phone:540-338-3330
Mailing Address - Fax:540-338-3392
Practice Address - Street 1:100 PURCELLVILLE GATEWAY DR
Practice Address - Street 2:STE D
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3486
Practice Address - Country:US
Practice Address - Phone:540-338-3330
Practice Address - Fax:540-338-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental