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Organization
FAMILIA DENTAL LLC
Active
Organization
FAMILIA DENTAL LLC
Active
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
200 W. LAKE ST., ADDISON, IL 60101-2513
(630) 628-3115
(630) 628-3116
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
1223G0001X
General Practice Dentistry
—
IL
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/04/2009
Last updated
06/25/2021
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