# FAMILIA DENTAL CARLSBAD LLC

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

## Provider details

- **NPI number:** 1811333800
- **Authorized official:** MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING PAYER RELATIONS MGR)
- **Authorized official phone:** (847) 453-7396

## Contact information

- **Practice address:** 2330 W PIERCE ST, CARLSBAD, NM 88220-3514
- **Practice address phone:** (575) 234-1125
- **Practice address fax:** (575) 234-1126
- **Mailing address:** 2050 EAST ALGONQUIN RD, SUITE 610, SCHAUMBURG, IL 60173-4144
- **Mailing address phone:** (888) 988-4066

## Taxonomy

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

## Other

- **Enumeration date:** 05/16/2013
- **Last updated:** 06/25/2021