Organization
FAMILIA DENTAL WEST GREEN BAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING & PAYER RELATIONS MGR)
(847) 453-7396
Entity
Organization
Contact information
Practice address
2280 W MASON ST, GREEN BAY, WI 54303-4707
(888) 988-4066
(847) 496-4850
Mailing address
2050 E ALGONQUIN RD STE 610, SCHAUMBURG, IL 60173-4166
(888) 988-4066
(847) 496-4850
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/10/2017
Last updated
10/15/2021
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