# FAMILIA DENTALCLOVIS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FAMILIA DENTAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841583291
- **Authorized official:** MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING & PAYER RELATIONS MGR)
- **Authorized official phone:** (847) 453-7396

## Contact information

- **Practice address:** 4017 N PRINCE ST, CLOVIS, NM 88101-9705
- **Practice address phone:** (575) 762-2757
- **Practice address fax:** (575) 762-2769
- **Mailing address:** 2050 E ALGONQUIN RD, 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 | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/18/2011
- **Last updated:** 06/24/2021