Healthcare Provider Details

I. General information

NPI: 1457246779
Provider Name (Legal Business Name): LEANDER ORAL SURGERY AND DENTAL IMPLANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 05/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 KAUFFMAN LOOP STE 130
GEORGETOWN TX
78628
US

IV. Provider business mailing address

2021 KAUFFMAN LOOP STE 130
GEORGETOWN TX
78628
US

V. Phone/Fax

Practice location:
  • Phone: 512-777-0009
  • Fax: 512-777-5009
Mailing address:
  • Phone: 512-777-0009
  • Fax: 512-777-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. MARION UGOCHUKWU HARRIS
Title or Position: OWNER
Credential: DDS, MD
Phone: 512-777-0009