Organization
FAMILIA DENTAL LOS LUNAS LLC
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
1620 MAIN ST NW, STE D, LOS LUNAS, NM 87031-4891
(505) 565-0651
(505) 565-2031
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
122300000X
Dentist
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/21/2014
Last updated
10/15/2021
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