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Organization
DECATUR 2012 LLC
Active
Organization
DECATUR 2012 LLC
Active
Other names
Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING PAYER RELATIONS MGR)
(847) 453-7396
Entity
Organization
Contact information
Practice address
141 E PERSHING RD, DECATUR, IL 62526-3213
(888) 988-4066
(847) 496-7603
Mailing address
2050 E ALGONQUIN RD, SUITE 610, SCHAUMBURG, IL 60173-4144
(888) 988-8406
(847) 496-7603
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/05/2012
Last updated
10/15/2021
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