Organization
FAMILIA DENTAL DAVENPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTALING & PAYER RELATIONS MGR)
(847) 453-7396
Entity
Organization
Contact information
Practice address
3301 W KIMBERLY RD STE 5, DAVENPORT, IA 52806-3047
(888) 988-4066
(847) 496-4850
Mailing address
2050 E ALGONQUIN RD STE 610, SUITE 610, SCHAUMBURG, IL 60173-4166
(847) 453-7396
(847) 453-7396
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
09227
IA
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
06/23/2016
Last updated
06/24/2021
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