# FAMILIA DENTAL EVANSVILLE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Familia Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336661628
- **Authorized official:** MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING & PAYER RELATIONS MAN)
- **Authorized official phone:** (847) 453-7396

## Contact information

- **Practice address:** 804 S. GREEN RIVER RD., STE A., EVANSVILLE, IN 47715-4106
- **Practice address phone:** (812) 324-1981
- **Practice address fax:** (812) 909-4930
- **Mailing address:** 2050 EAST ALGONQUIN ROAD, SUITE 610, SCHAUMBURG, IL 60173-4166
- **Mailing address phone:** (847) 453-7396
- **Mailing address fax:** (847) 453-7396

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 07/09/2017
- **Last updated:** 06/25/2021