Organization
FAMILIA DENTAL INDIANAPOLIS LAFAYETTE, LLC
Active
Other names
Familia Dental
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING & PAYER RELATION MANA)
(847) 453-7396
Entity
Organization
Contact information
Practice address
4740 W. 38TH ST., INDIANAPOLIS, IN 46254-3318
(317) 315-1251
(317) 757-3318
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
12011918A
IN
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/12/2017
Last updated
06/23/2021
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