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Organization
FAMILIA DENTAL ROS LLC
Active
Organization
FAMILIA DENTAL ROS LLC
Active
Other names
Familia Dental
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
2600 N MAIN ST, ROSWELL, NM 88201-6554
(575) 208-1520
(575) 208-1518
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
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/18/2011
Last updated
10/15/2021
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