# FAMILIA DENTAL SPFW PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1619388063
- **Authorized official:** MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING PAYER RELATIONS MGR)
- **Authorized official phone:** (847) 453-7396

## Contact information

- **Practice address:** 100 E PETTIT AVE, 1A, FORT WAYNE, IN 46806-3003
- **Practice address phone:** (888) 988-4066
- **Practice address fax:** (847) 496-7603
- **Mailing address:** 2050 E ALGONQUIN RD, SUITE 610, SCHAUMBURG, IL 60173-4144
- **Mailing address phone:** (888) 988-4066
- **Mailing address fax:** (847) 496-7603

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 05/19/2014
- **Last updated:** 10/15/2021