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Organization
FAMILIA DENTAL MKE MIDTOWN LLC
Active
Organization
FAMILIA DENTAL MKE MIDTOWN LLC
Active
Other names
Familia Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING & PAYOR RELATIONS MAN)
(847) 453-7393
Entity
Organization
Contact information
Practice address
5341 W FOND DU LAC AVE, MILWAKEE, WI 53216-1365
(414) 871-0827
(414) 871-0859
Mailing address
2050 E ALGONQUIN ROAD, SUITE 610, SCHAUMBURG, IL 60173-4166
(847) 453-7396
(847) 453-9390
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/18/2021
Last updated
06/18/2021
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