# FAMILIA DENTAL LUBBOCK PLLC

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

## Provider details

- **NPI number:** 1902126774
- **Authorized official:** MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING &PAYER RELATIONS MANA)
- **Authorized official phone:** (847) 453-7396

## Contact information

- **Practice address:** 2402 19TH ST., LUBBOCK, TX 79401-4414
- **Practice address phone:** (806) 368-3731
- **Practice address fax:** (806) 368-5925
- **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 | 22535 | TX | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/03/2010
- **Last updated:** 06/25/2021