Organization
FAMILIA DENTAL FORT WAYNE PLLC
Active
Other names
Familia Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING PAYER RELATIONS MGR)
(847) 453-7396
Entity
Organization
Contact information
Practice address
5328 COLDWATER RD, FORT WAYNE, IN 46825-5445
(888) 988-4066
(847) 496-7603
Mailing address
2050 E ALGONQUIN RD, 610, SCHAUMBURG, IL 60173-4144
(888) 988-4066
(847) 496-7603
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/25/2013
Last updated
10/15/2021
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