Provider Demographics
NPI:1487135364
Name:IMPLANT CONCIERGE, LLC
Entity type:Organization
Organization Name:IMPLANT CONCIERGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-977-2228
Mailing Address - Street 1:11503 NW MILITARY HWY STE 212
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1895
Mailing Address - Country:US
Mailing Address - Phone:866-977-2228
Mailing Address - Fax:
Practice Address - Street 1:11503 NW MILITARY HWY STE 212
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1895
Practice Address - Country:US
Practice Address - Phone:866-977-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment