Provider Demographics
NPI:1457246779
Name:LEANDER ORAL SURGERY AND DENTAL IMPLANTS
Entity type:Organization
Organization Name:LEANDER ORAL SURGERY AND DENTAL IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:UGOCHUKWU
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:512-777-0009
Mailing Address - Street 1:2021 KAUFFMAN LOOP STE 130
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628
Mailing Address - Country:US
Mailing Address - Phone:512-777-0009
Mailing Address - Fax:512-777-5009
Practice Address - Street 1:2021 KAUFFMAN LOOP STE 130
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628
Practice Address - Country:US
Practice Address - Phone:512-777-0009
Practice Address - Fax:512-777-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT1093OtherTEXAS MEDICAL LICENSE
TX36909OtherTEXAS DENTAL LICENSE