# FAMILIA DENTAL INDIANAPOLIS LAFAYETTE, LLC

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

## Provider details

- **NPI number:** 1568999241
- **Authorized official:** BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING & PAYER RELATION MANA)
- **Authorized official phone:** (847) 453-7396

## Contact information

- **Practice address:** 4740 W. 38TH ST., INDIANAPOLIS, IN 46254-3318
- **Practice address phone:** (317) 315-1251
- **Practice address fax:** (317) 757-3318
- **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 | 12011918A | IN | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/12/2017
- **Last updated:** 06/23/2021