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Organization
FAMILIA DENTAL INDIANAPOLIS LAFAYETTE, LLC
Active
Organization
FAMILIA DENTAL INDIANAPOLIS LAFAYETTE, LLC
Active
Other names
Familia Dental
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING & PAYER RELATION MANA)
(847) 453-7396
Entity
Organization
Contact information
Practice address
4740 W. 38TH ST., INDIANAPOLIS, IN 46254-3318
(317) 315-1251
(317) 757-3318
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
12011918A
IN
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
05/12/2017
Last updated
06/23/2021
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