Organization
FAMILIA DENTAL MKE MIDTOWN LLC
Active
Other names
Familia Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING & PAYOR RELATIONS MAN)
(847) 453-7393
Entity
Organization
Contact information
Practice address
5341 W FOND DU LAC AVE, MILWAKEE, WI 53216-1365
(414) 871-0827
(414) 871-0859
Mailing address
2050 E ALGONQUIN ROAD, SUITE 610, SCHAUMBURG, IL 60173-4166
(847) 453-7396
(847) 453-9390
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/18/2021
Last updated
06/18/2021
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