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Organization
FAMILIA DENTAL GREEN BAY EAST LLC
Active
Organization
FAMILIA DENTAL GREEN BAY EAST LLC
Active
Other names
Familia Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING & PAYER RELATIONS MAN)
(847) 453-7396
Entity
Organization
Contact information
Practice address
1931 MAIN ST., GREEN BAY, WI 54302-3920
(920) 499-2770
(920) 634-2733
Mailing address
2050 EAST ALGONQUIN ROAD, SUITE 610, SCHAUMBURG, IL 60173-4166
(847) 453-7396
(847) 453-7396
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/31/2016
Last updated
10/15/2021
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