Organization
FAMILIA DENTAL NB PLLC
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
161 CREEKSIDE WAY, STE. 102, NEW BRAUNFELS, TX 78130-6391
(830) 632-6369
(830) 632-5778
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
22535
TX
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2054611-01
—
TX
Enumeration date
05/27/2010
Last updated
06/25/2021
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